Simultaneous Robot-Assisted Nephroureterectomy and Cystectomy in Patients with Uremia and Multifocal Urothelial Carcinoma

摘要

BACKGROUND AND PURPOSE: In Taiwan, patients with uremia have a high risk of the development of multifocal urothelial carcinoma. We report on eight patients with uremia and urothelial carcinoma who underwent simultaneous robot-assisted laparoscopic nephroureterectomy and radical cystectomy (RANUC). PATIENTS AND METHODS: Between April 2006 and August 2010, eight patients with uremia (five women, three men; mean age 66.9 y) who were receiving dialysis underwent RANUC. Patients were classified into two groups: Group I, cases 1 to 4 occurring between April 2006 and June 2009; and group II, cases 5 to 8 occurring between July 2009 and August 2010. RESULTS: The mean operative time was significantly shorter in group II (252.5±35.0 min vs 360±25.8 min; P=0.029). The estimated blood loss was also significantly less in group II (332.5±53.8 mL vs 660±137.4 mL; P=0.029). The blood transfusion rate was 75% in group I and 0% in group II. The postoperative stay was reduced from 8.5 days for group I to 7 days for group II. No perioperative morbidity and mortality were noted in either group. None of the patients had died at the short- and intermediate-term mean follow-up of 28.1 months (range 2-54 mos). CONCLUSIONS: Simultaneous RANUC are feasible and can be performed safely. Long-term oncologic data are awaited; however, at intermediate-term oncologic follow-up, results are satisfactory. RANUC for uremic patients with multifocal urothelial carcinoma necessitating complete urinary tract exenteration is a viable option and patients experience a rapid convalescence.