Efficacy And Safety Of Robot-assisted Laparoscopic Segmental Ureterectomy Combined With Bladder Flap Forming And Radical Nephreterectomy In The Treatment Of Low-risk Lower Ureteral Carcinoma

Objective:To evaluate the clinical efficacy and safety of robot-assisted laparoscopic segmental ureterectomy(RASU)combined with bladder flap forming and robot-assisted laparoscopic radical nephreterectomy(RANU)in the treatment of low-risk lower ureteral carcinoma.Methods:Clinical data of 49 patients with ureteral carcinoma admitted to the Department of Urology of our hospital from October 2014 to September 2020 were collected.They were divided into RASU+bladder flap group and RARU group according to the operation method.Parameters before and after surgery and perioperative complications of the two groups were recorded,including operation time,intraoperative blood loss,changes in renal function before and after surgery,etc.Review data of patients during postoperative follow-up were collected,including cystoscopy,imaging examination,urine exudation cytology,etc.Kaplan-Meier method was used to draw survival curves to compare the estimated 5-year Intra-vesical recurrence free survival rate,cancer-specific survival rate and overall survival rate between the two surgical methods.Results:There were 12 and 37 patients in RASU+bladder flap group and RARU group,respectively.There were no statistical differences in gender,age,chief complaint and BMI between the two groups.All robotic operations were successfully completed in one time without conversion to laparotomy.The mean operation time of RASU+bladder flap group was shorter(148.75±22.27 vs.183.24±40.06 min,P<0.01),the mean intraoperative blood loss was less(40.42±12.33 vs.106.76±52.30 ml,P<0.01),the removal time of drainage tube(4.33±1.92 vs.6.11±2.25 d,P=0.018)and the postoperative hospital stay(7.17±0.83 vs.9.30±3.04 d,P=0.021)were shorter,and the differences were statistically significant.In terms of postoperative renal function related indicators,RASU+bladder flap group had significantly lower postoperative serum creatinine(85.81±11.58 vs.121.88±27.24 umol/L,P<0.01),while the clearance rate of endogenous creatinine(68.50±15.24 vs.42.56±12.78ml/min,P<0.01),estimated glomerular filtration rate(87.92±15.58 vs.59.21±18.47ml/min?1.73m~2,P<0.01).The 5-year Intra-vesical recurrence free survival rate of 2groups were 71.1%and 69.3%,cancer-specific survival rates were 60.0%and69.5%,and overall survival rates were 60.0%and 57.0%,respectively,with no statistical significance(P>0.05).Conclusions:Robot-assisted laparoscopic segmental ureterectomy combined with bladder flap forming and robot-assisted laparoscopic radical nephreterectomy are safe and effective treatment methods for lower ureteral carcinoma.Compared with RARU group,RASU+bladder flap group has more advantages in operative time,intraoperative blood loss,postoperative hospital stay and renal function protection.