Modified Retroperitoneal Laparoscopy Combined With Transurethral Electrotomy For The Treatment Of Urothelial Carcinoma Of The Upper Urinary Tract

Objective: To observe the clinical effect of retroperitoneal laparoscopy combined with transurethral resection endoscopy in the treatment of upper urinary tract urothelial carcinoma.Methods: The clinical and perioperative data of patients with upper urinary tract epithelioma who were admitted to the Department of Urology of the Eastern Theater General Hospital of the Chinese people’s Liberation Army from September 2014 to March 2020 were reviewed and collected.Results: Finally,53 patients were included,including traditional operation group(n =32)and improved technique group(n = 21).There was no significant difference in age,sex and tumor affected side between the two groups(P >0.05).All the operations were successful.In one case of lower ureteral tumor,the ureter was inadvertently ruptured and the abdominal cavity and incision were closed after repeated irrigation.In the improved group,the operation time,intraoperative bleeding,intestinal function recovery,cumulative drainage volume,catheter indwelling time and catheter indwelling time were 183.81 ±18.83,80.95 ±77.13 min,30.0 ±4.6h,192.19 ±90.29 ml,3.14 ±1.01 day and 4.53 ±1.36 day,respectively.The average hospital stay was 8.21±3.72 day.In the traditional group,the operation time was 180.8 ±17.79 min,the intraoperative bleeding was 133.28 ±85.06 h,the intestinal function recovery was 31.0±5.30 h,the cumulative drainage volume was 167.06 ±86.80 ml,the catheter indwelling time was 180.8 ±1.06 day,the catheter indwelling time was 4.22±1.43 day,and the average hospital stay was 7.83 ±4.12 day.The bleeding during operation in the improved group was less than that in the traditional group,and the difference was statistically significant(P=0.027).In the improved group,the 3-year overall survival rate(overall survival,OS)was 75.0%,the tumor-specific survival rate(cancer specific survival,CSS)87.5%,the bladder recurrence-free survival rate(intra-vesical recurrence,Iv RFS)69.6%),and the disease-free survival rate(disease free survival,DFS)58.9%.In the traditional group,OS74.0%,CSS88.4%,IVRFS67.8%,DFS57.9%was performed 3 years after operation.There was no statistical difference in the abovementioned indexes between the two groups.Conclusion: Compared with the traditional transurethral surgery,the improved technique is more accurate and effective,and can be used in the treatment of urothelial carcinoma of the upper urinary tract,which is not inferior to other minimally invasive techniques.however,a prospective randomized controlled trial with larger sample size and longer follow-up time is needed to confirm this conclusion.