The Clinical Study For Reducing Bladder Cancer Recurrence After Surgical Treatment For Renal Pelvic Carcinoma

ObjectiveTo investigate the clinical methods for reducing bladder cancer recurrence after surgical treatment for renal pelvic carcinoma.MethodsOf the 258 patients undergoing total nephroureteretomy for clinically localized transitional cell carcinoma of the renal pelvis, the data of 227 patients with follow-up results were analyzed retrospectively, including 126 cases of male and 101 cases of female, and the age was 34 to 78 years old.176 cases had gross hematuria,51 cases with lumbar pain. There were 2 kinds of technique used in the dissection of bladder wall circumferentially around the ureteral orifice. A:dissection along the ipsilateral ureter to the bladder wall; B:dissection along the vas deferens to the bladder wall circumferentially around the ipsilateral ureteral orifice and division of the lateral vesical ligament to reach the seminal vesicle. Prophylactic intravesical chemotherapy: method 1:intravesical chemotherapy was started from the operation day, and the intravesical chemotherapy was given once a week,10 times in total; method 2: intravesical chemotherapy was given on the operation day, and was administrated once a week from the 4th week after operation,10 times in total; method 3:intravesical chemotherapy was given once a week from the 4th week after operation,10 times in total. The time of follow-up was 1 to 10 years. Chi-square test and Logistic regression were used to analyzed the recurrence rate of bladder cancer. ResultsRecurrence rate of bladder cancer was 27.8%(63/227). The recurrence rate of bladder cancer in patients using technique A and B was 18%(7/39) and 12.5%(3/24), respectively (P<0.05). The postoperative recurrence rate of bladder cancer in patients using 3 kinds of intravesical chemotherapy regimen was 17.9%(11/67),20.8%(10/48) and 33.3%(17/51), respectively. There was significant difference between the recurrence rates of patients using method 1 and method 3 intravesical chemotherapy (P <0.05). The recurrent rates in the patients with low and high grade renal pelvic cancer were 18.8%(16/85) and 33.1%(47/142), respectively (P<0.05). The recurrent rates in the patients with Ta～T1 and T2～T3 were 20.8%(20/96) and 32.8%(43/131), respectively (P<0.05). The recurrent rates of the patients with the tumor diameter>2 cm and≤2 cm was 41.3%(38/92) and 18.5%(25/35), respectively (P<0.01).ConclusionComplete removal of the bladder mucosa circumferentially around the ureteral orifice, administration of the prophylactic intravesical chemotherapy from the operation day and instillation once a week may be a useful approach to reduce the recurrence of bladder cancer after operation for renal pelvic carcinoma.