浸潤性腎盂癌に対する腹腔鏡下腎尿管全摘除術
症状出現率の低さ，診断のむずかしさより，腎盂尿管癌は予後不良な疾患である．同じ組織学的ステージでも，腎盂癌は一般的に尿管癌より予後がよい印象がある．これは腎盂と尿管の組織学的構造の差による．このことから，腎盂癌と尿管癌は分けて考える方がよいと我々は考える．本稿では，腎盂癌と尿管癌の進展形式の比較および腎実質浸潤腎盂癌の病理組織学的ステージの新しい考え方について述べる．また，浸潤性腎盂癌に限っての腹腔鏡下手術の治療成績の報告はないことから，今回，浸潤性腎盂癌における腹腔鏡下手術の治療成績を開腹手術と後ろ向きに比較検討した．...
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| Published in | Japanese Journal of Endourology Vol. 27; no. 2; pp. 251 - 257 |
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| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本泌尿器内視鏡学会
01.09.2014
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| Subjects | |
| Online Access | Get full text |
| ISSN | 2186-1889 2187-4700 |
| DOI | 10.11302/jsejje.27.251 |
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| Abstract | 症状出現率の低さ，診断のむずかしさより，腎盂尿管癌は予後不良な疾患である．同じ組織学的ステージでも，腎盂癌は一般的に尿管癌より予後がよい印象がある．これは腎盂と尿管の組織学的構造の差による．このことから，腎盂癌と尿管癌は分けて考える方がよいと我々は考える．本稿では，腎盂癌と尿管癌の進展形式の比較および腎実質浸潤腎盂癌の病理組織学的ステージの新しい考え方について述べる．また，浸潤性腎盂癌に限っての腹腔鏡下手術の治療成績の報告はないことから，今回，浸潤性腎盂癌における腹腔鏡下手術の治療成績を開腹手術と後ろ向きに比較検討した． |
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| AbstractList | 「要旨」症状出現率の低さ, 診断のむずかしさより, 腎盂尿管癌は予後不良な疾患である. 同じ組織学的ステージでも, 腎盂癌は一般的に尿管癌より予後がよい印象がある. これは腎盂と尿管の組織学的構造の差による. このことから, 腎盂癌と尿管癌は分けて考える方がよいと我々は考える. 本稿では, 腎盂癌と尿管癌の進展形式の比較および腎実質浸潤腎盂癌の病理組織学的ステージの新しい考え方について述べる. また, 浸潤性腎盂癌に限っての腹腔鏡下手術の治療成績の報告はないことから, 今回, 浸潤性腎盂癌における腹腔鏡下手術の治療成績を開腹手術と後ろ向きに比較検討した. 「はじめに」腎盂尿管癌は予後不良な疾患である. それは, 診断時に膀胱癌では15-25%が浸潤癌であるのに対して腎盂癌では60%が浸潤癌であること, 症状出現率が低く, 診断がむずかしいことが原因である. 膀胱癌では, T2以上を浸潤癌とすることが一般的であるが, 腎盂癌, 尿管癌については浸潤癌の定義が一定ではない. 症状出現率の低さ，診断のむずかしさより，腎盂尿管癌は予後不良な疾患である．同じ組織学的ステージでも，腎盂癌は一般的に尿管癌より予後がよい印象がある．これは腎盂と尿管の組織学的構造の差による．このことから，腎盂癌と尿管癌は分けて考える方がよいと我々は考える．本稿では，腎盂癌と尿管癌の進展形式の比較および腎実質浸潤腎盂癌の病理組織学的ステージの新しい考え方について述べる．また，浸潤性腎盂癌に限っての腹腔鏡下手術の治療成績の報告はないことから，今回，浸潤性腎盂癌における腹腔鏡下手術の治療成績を開腹手術と後ろ向きに比較検討した． |
| Author | 佐々, 直人 馬嶋, 剛 深津, 顕俊 服部, 良平 後藤, 百万 木村, 亨 佐野, 友康 都築, 豊徳 |
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| References | 6) Yafi FA, Novara G, Shariat SF, et al. Impact of tumour location versus multifocality in patients with upper tract urothelial carcinoma treated with nephroureterectomy and bladder cuff excision : a homogeneous series without perioperative chemotherapy. BJU Int 2012 ; 1102 : E7-13. 8) Sobin L, Gospodarowicz M, Wittekind C. TNM classification of malignant tumours. Urological tumours, renal pelvis and ureter. ed. 7. rev. New York, NY : Wiley-Blackwell ; 2009. p. 258-61. 13) Capitanio U, Shariat SF, Isbarn H, et al. Comparison of oncologic outcomes for open and laparoscopic nephroureterectomy : a multi-institutional analysis of 1249 cases. Eur Urol 2009 ; 56 : 1-9. 12) Sassa N, Tsuzuki T, Fukatsu A, et al. Is pT3 urothelial carcinoma of the renal pelvis a homogeneous disease entity? Proposal for a new subcategory of the pT3 classification. Histopathology 2012 26 ; 61 (4) : 620-628 20) Roscigno M, Cozzarini C, Bertini R, et al. Prognostic value of lymph node dissection in patients with muscle-invasive transitional cell carcinoma of the upper urinary tract. Eur Urol 2008 ; 53 (4) : 794-802. 3) Margulis V, Shariat SF, Matin SF, et al. Outcomes of radical nephroureterectomy : a series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer 2009 ; 115 : 1224-33. 10) Roscigno M, Cha EK, Rink M, et al. International validation of the prognostic value of subclassification for AJCC stage pT3 upper tract urothelial carcinoma of the renal pelvis. BJU Int 2012 ; 110 (5) : 674-81. 7) Cosentino M, Palou J, Gaya JM, et al. Upper urinary tract urothelial cell carcinoma : location as a predictive factor for concomitant bladder carcinoma. World J Urol 2013 ; 31 : 141-5. 16) Walton TJ, Novara G, Matsumoto K, et al. Oncological outcomes after laparoscopic and open radical nephroureterectomy : results from an international cohort. BJU Int 2011 ; 108 : 406-12. 2) Hall MC, Womack S, Sagalowsky AI, et al. Prognostic factors, recurrence, and survival in transitional cell carcinoma of the upper urinary tract : a 30-year experience in 252 patients. Urology 1998 ; 52 (4) : 594-601 17) Ariane MM, Colin P, Ouzzane A, et al. Assessment of oncologic control obtained after open versus laparoscopic nephroureterectomy for upper urinary tract urothelial carcinomas (UUT-UCs) : results from a large French multicenter collaborative study. Ann Surg Oncol 2012 ; 19 : 301-8. 14) Favaretto RL, Shariat SF, Chade DC, et al. Comparison between laparoscopic and open radical nephroureterectomy in a contemporary group of patients : are recurrence and disease-specific survival associated with surgical technique? Eur Urol 2010 ; 58 : 645-51. 1) Rouprêt M, Babjuk M, Compérat E, et al. European guidelines on upper tract urothelial carcinomas : 2013 update. Eur Urol 2013 ; 63 (6) : 1059-71. 5) Isbarn H, Jeldres C, Shariat SF, et al. Location of the primary tumor is not an independent predictor of cancer specific mortality in patients with upper urinary tract urothelial carcinoma. J Urol 2009 ; 182 : 2177-81. 19) Kondo T, Nakazawa H, Ito F, et al. Impact of the extent of regional lymphadenectomy on the survival of patients with urothelial carcinoma of the upper urinary tract. J Urol 2007 ; 178 : 1212-7. 22) May M, Herrmann E, Bolenz C, et al. Lymph node density affects cancer-specific survival in patients with lymph node-positive urothelial bladder cancer following radical cystectomy. Eur Urol, 2011 ; 59 : 712-718. 18) Kamihira O, Hattori R, Yamaguchi A, et al. Laparoscopic radical nephroureterectomy : a multicentre analysis in Japan. Eur Urol 2009 ; 55 : 1397-409. 9) Rink M, Robinson BD, Green DA, et al. Impact of histological variants on clinical outcomes of patients with upper urinary tract urothelial carcinoma. J Urol 2012 ; 188 : 398-404. 4) Lughezzani G, Burger M, Margulis V, et al. Prognostic factors in upper urinary tract urothelial carcinomas : a comprehensive review of the current literature. Eur Urol 2012 ; 62 : 100-14. 11) Shariat SF1, Zigeuner R, Rink M, et al. Subclassification of pT3 urothelial carcinoma of the renal pelvicalyceal system is associated with recurrence-free and cancer-specific survival : proposal for a revision of the current TNM classification. Eur Urol 2012 ; 62 (2) : 224-31. 15) Ni S, Tao W, Chen Q, et al. Laparoscopic versus open nephroureterectomy for the treatment of upper urinary tract urothelial carcinoma : a systematic review and cumulative analysis of comparative studies. Eur Urol 2012 ; 61 : 1142-53. 21) Abe T, Shinohara N, Muranaka M. Role of lymph node dissection in the treatment of urothelial carcinoma of the upper urinary tract : multi-institutional relapse analysis and immunohistochemical re-evaluation of negative lymph nodes. Eur J Surg Oncol 2010 ; 36 (11) : 1085-91. |
| References_xml | – reference: 18) Kamihira O, Hattori R, Yamaguchi A, et al. Laparoscopic radical nephroureterectomy : a multicentre analysis in Japan. Eur Urol 2009 ; 55 : 1397-409. – reference: 21) Abe T, Shinohara N, Muranaka M. Role of lymph node dissection in the treatment of urothelial carcinoma of the upper urinary tract : multi-institutional relapse analysis and immunohistochemical re-evaluation of negative lymph nodes. Eur J Surg Oncol 2010 ; 36 (11) : 1085-91. – reference: 5) Isbarn H, Jeldres C, Shariat SF, et al. Location of the primary tumor is not an independent predictor of cancer specific mortality in patients with upper urinary tract urothelial carcinoma. J Urol 2009 ; 182 : 2177-81. – reference: 16) Walton TJ, Novara G, Matsumoto K, et al. Oncological outcomes after laparoscopic and open radical nephroureterectomy : results from an international cohort. BJU Int 2011 ; 108 : 406-12. – reference: 17) Ariane MM, Colin P, Ouzzane A, et al. Assessment of oncologic control obtained after open versus laparoscopic nephroureterectomy for upper urinary tract urothelial carcinomas (UUT-UCs) : results from a large French multicenter collaborative study. Ann Surg Oncol 2012 ; 19 : 301-8. – reference: 15) Ni S, Tao W, Chen Q, et al. Laparoscopic versus open nephroureterectomy for the treatment of upper urinary tract urothelial carcinoma : a systematic review and cumulative analysis of comparative studies. Eur Urol 2012 ; 61 : 1142-53. – reference: 6) Yafi FA, Novara G, Shariat SF, et al. Impact of tumour location versus multifocality in patients with upper tract urothelial carcinoma treated with nephroureterectomy and bladder cuff excision : a homogeneous series without perioperative chemotherapy. BJU Int 2012 ; 1102 : E7-13. – reference: 12) Sassa N, Tsuzuki T, Fukatsu A, et al. Is pT3 urothelial carcinoma of the renal pelvis a homogeneous disease entity? Proposal for a new subcategory of the pT3 classification. Histopathology 2012 26 ; 61 (4) : 620-628 – reference: 19) Kondo T, Nakazawa H, Ito F, et al. Impact of the extent of regional lymphadenectomy on the survival of patients with urothelial carcinoma of the upper urinary tract. J Urol 2007 ; 178 : 1212-7. – reference: 2) Hall MC, Womack S, Sagalowsky AI, et al. Prognostic factors, recurrence, and survival in transitional cell carcinoma of the upper urinary tract : a 30-year experience in 252 patients. Urology 1998 ; 52 (4) : 594-601 – reference: 11) Shariat SF1, Zigeuner R, Rink M, et al. Subclassification of pT3 urothelial carcinoma of the renal pelvicalyceal system is associated with recurrence-free and cancer-specific survival : proposal for a revision of the current TNM classification. Eur Urol 2012 ; 62 (2) : 224-31. – reference: 4) Lughezzani G, Burger M, Margulis V, et al. Prognostic factors in upper urinary tract urothelial carcinomas : a comprehensive review of the current literature. Eur Urol 2012 ; 62 : 100-14. – reference: 14) Favaretto RL, Shariat SF, Chade DC, et al. Comparison between laparoscopic and open radical nephroureterectomy in a contemporary group of patients : are recurrence and disease-specific survival associated with surgical technique? Eur Urol 2010 ; 58 : 645-51. – reference: 8) Sobin L, Gospodarowicz M, Wittekind C. TNM classification of malignant tumours. Urological tumours, renal pelvis and ureter. ed. 7. rev. New York, NY : Wiley-Blackwell ; 2009. p. 258-61. – reference: 22) May M, Herrmann E, Bolenz C, et al. Lymph node density affects cancer-specific survival in patients with lymph node-positive urothelial bladder cancer following radical cystectomy. Eur Urol, 2011 ; 59 : 712-718. – reference: 3) Margulis V, Shariat SF, Matin SF, et al. Outcomes of radical nephroureterectomy : a series from the Upper Tract Urothelial Carcinoma Collaboration. Cancer 2009 ; 115 : 1224-33. – reference: 9) Rink M, Robinson BD, Green DA, et al. Impact of histological variants on clinical outcomes of patients with upper urinary tract urothelial carcinoma. J Urol 2012 ; 188 : 398-404. – reference: 1) Rouprêt M, Babjuk M, Compérat E, et al. European guidelines on upper tract urothelial carcinomas : 2013 update. Eur Urol 2013 ; 63 (6) : 1059-71. – reference: 10) Roscigno M, Cha EK, Rink M, et al. International validation of the prognostic value of subclassification for AJCC stage pT3 upper tract urothelial carcinoma of the renal pelvis. BJU Int 2012 ; 110 (5) : 674-81. – reference: 13) Capitanio U, Shariat SF, Isbarn H, et al. Comparison of oncologic outcomes for open and laparoscopic nephroureterectomy : a multi-institutional analysis of 1249 cases. Eur Urol 2009 ; 56 : 1-9. – reference: 20) Roscigno M, Cozzarini C, Bertini R, et al. Prognostic value of lymph node dissection in patients with muscle-invasive transitional cell carcinoma of the upper urinary tract. Eur Urol 2008 ; 53 (4) : 794-802. – reference: 7) Cosentino M, Palou J, Gaya JM, et al. Upper urinary tract urothelial cell carcinoma : location as a predictive factor for concomitant bladder carcinoma. World J Urol 2013 ; 31 : 141-5. |
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| Snippet | 症状出現率の低さ，診断のむずかしさより，腎盂尿管癌は予後不良な疾患である．同じ組織学的ステージでも，腎盂癌は一般的に尿管癌より予後がよい印象がある．これは腎... 「要旨」症状出現率の低さ, 診断のむずかしさより, 腎盂尿管癌は予後不良な疾患である. 同じ組織学的ステージでも, 腎盂癌は一般的に尿管癌より予後がよい印象がある.... |
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| SubjectTerms | リンパ節郭清 尿路上皮癌 腎尿管全摘除術 腎盂癌 腹腔鏡手術 |
| Title | 浸潤性腎盂癌に対する腹腔鏡下腎尿管全摘除術 |
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