臨床泌尿器科78巻1号

2024年01月発行

特集 泌尿器腹腔鏡手術ガイドラインを紐解く―EBMに基づいた手術選択

ハイリスク上部尿路上皮癌に対する腎尿管全摘除術―ロボット手術は開腹手術や腹腔鏡下手術を越えるのか？

著者： 近藤恒徳¹

所属機関： ¹東京女子医科大学附属足立医療センター泌尿器科

ページ範囲：P.22 - P.31

文献概要

▶ポイント

・上部尿路上皮癌に対する腎尿管全摘除術では，ランダム化比較試験によりT3以上の局所進行がんでは腹腔鏡手術のがん制御が劣ることから，『泌尿器腹腔鏡手術ガイドライン2020年版』では推奨されていない．

・しかし，腹腔鏡手術に慣れた術者による局所進行がんに対する手術では開腹手術と手術成績に大きな差がないことから，症例を選んで行うことが推奨されている．

・ロボット手術によりリンパ節郭清，膀胱カフ切除の体腔鏡下で開腹手術を同様のがん制御で行える可能性があり，今後エビデンスの蓄積によりガイドラインの推奨が変わってくる可能性が期待される．

参考文献

1） Rouprêt M, et al : Guidelines on upper urinary tract urothelical cell carcinoma. Arnhem, the Netherlands, European Association of Urology, 2023

2） 日本泌尿器科学会 （編） : 腎盂・尿管癌診療ガイドライン2023年版. 医学図書出版, 2023

3） Margulis V, et al : Outcomes of radical nephroureterectomy : a series from the upper tract urothelial Carcinoma Collaboration. Cancer 115 : 1224-1233, 2009

4） Simone G, et al : Laparoscopic versus open nephroureterectomy : perioperative and oncologic outcomes from a randomised prospective study. Eur Urol 56 : 520-526, 2009

5） Grossmann NC, et al : Comparing Oncological and Perioperative Outcomes of Open versus Laparoscopic versus Robotic Radical Nephroureterectomy for the Treatment of Upper Tract Urothelial Carcinoma : A Multicenter, Multinational, Propensity Score-Matched Analysis. Cancers （Basel） 15 : 1409, 2023

6） Li KP, et al : Comparison between robot-assisted versus open nephroureterectomy for upper tract urothelial carcinoma : outcomes from a pooled analysis. J Robot Surg 17 : 1227-1238, 2023

7） Clayman RV, et al : Laparoscopic nephroureterectomy : initial clinical case report. J Laparoendosc Surg 1 : 343-349, 1991

8） Jarrett TW, et al : Laparoscopic nephroureterectomy for the treatment of transitional cell carcinoma of the upper urinary tract. Urology 57 : 448-453, 2001

9） Muntener M, et al : Long-term oncologic outcome after laparoscopic radical nephroureterectomy for upper tract transitional cell carcinoma. Eur Urol 51 : 1639-1644, 2007

10） Rassweiler JJ, et al : Laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma : is it better than open surgery? Eur Urol 46 : 690-697, 2004

11） Terakawa T, et al : Retroperitoneoscopic nephroureterectomy for upper urinary tract cancer : a comparative study with conventional open retroperitoneal nephroureterectomy. J Endourol 22 : 1693-1699, 2008

12） Abe T, et al : Comparative study of lymph node dissection, and oncological outcomes of laparoscopic and open radical nephroureterectomy for patients with urothelial carcinoma of the upper urinary tract undergoing regional lymph node dissection. Jpn J Clin Oncol 48 : 1001-1011, 2018

13） Miyazaki J, et al : Laparoscopic Versus Open Nephroureterectomy in Muscle-Invasive Upper Tract Urothelial Carcinoma : Subanalysis of the Multi-Institutional National Database of the Japanese Urological Association. J Endourol 30 : 520-525, 2016

14） Seisen T, et al : A Systematic Review and Meta-analysis of Clinicopathologic Factors Linked to Intravesical Recurrence After Radical Nephroureterectomy to Treat Upper Tract Urothelial Carcinoma. Eur Urol 67 : 1122-1133, 2015

15） Rose K, et al : Robotic assisted retroperitoneoscopic nephroureterectomy -- first experience and the hybrid port technique. Int J Clin Pract 60 : 12-14, 2006

16） Xia L, et al : National trends and disparities of minimally invasive surgery for localized renal cancer, 2010 to 2015. Urol Oncol 37 : 182.e17-182.e27, 2019

17） Tinay I, et al : Trends in utilization, perioperative outcomes and costs for nephroureterectomies in the management of upper tract urothelial carcinoma : a 10-year population-based analysis. BJU Int 117 : 954-960, 2016

18） Bae H, et al : Robotic Radical Nephroureterectomy with Bladder Cuff Excision for Upper Tract Urothelial Carcinoma : A Trend Analysis of Utilization and a Comparative Study. Cancers （Basel） 14 : 2497, 2022

19） Kenigsberg AP, et al : Robotic Nephroureterectomy vs Laparoscopic Nephroureterectomy : Increased Utilization, Rates of Lymphadenectomy, Decreased Morbidity Robotically. J Endourol 35 : 312-318, 2021

20） Kondo T, et al : Role of lymphadenectomy in the management of urothelial carcinoma of the bladder and the upper urinary tract. Int J Urol 19 : 710-721, 2012

21） Kondo T, et al : Template-based lymphadenectomy in urothelial carcinoma of the renal pelvis : a prospective study. Int J Urol 21 : 453-459, 2014

22） Abe T, et al : Outcome of regional lymphadenectomy in accordance with primary tumor location on laparoscopic nephroureterectomy for urothelial carcinoma of the upper urinary tract : A prospective study. J Endourol 29 : 304-309, 2015

23） Pearce SM, et al : The effect of surgical approach on performance of lymphadenectomy and perioperative morbidity for radical nephroureterectomy. Urol Oncol 34 : 121 e15-21, 2016

24） Clements MB, et al : Robotic-Assisted Surgery for Upper Tract Urothelial Carcinoma : A Comparative Survival Analysis. Ann Surg Oncol 25 : 2550-2562, 2018

25） Lenis AT, et al : Role of surgical approach on lymph node dissection yield and survival in patients with upper tract urothelial carcinoma. Urol Oncol 36 : 9.e1-9.e9, 2018

26） Veccia A, et al : Robotic versus other nephroureterectomy techniques : a systematic review and meta-analysis of over 87,000 cases. World J Urol 38 : 845-852, 2020

27） Lughezzani G, et al : Should bladder cuff excision remain the standard of care at nephroureterectomy in patients with urothelial carcinoma of the renal pelvis? A population-based study. Eur Urol 57 : 956-962, 2010

28） Xylinas E, et al : Impact of Distal Ureter Management on Oncologic Outcomes Following Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma. Eur Urol 65 : 210-217, 2014

29） Braun AE, et al : Controversies in management of the bladder cuff at nephroureterectomy. Transl Androl Urol 9 : 1868-1880, 2020

30） Phé V, et al : Does the surgical technique for management of the distal ureter influence the outcome after nephroureterectomy? BJU Int 108 : 130-138, 2011

robotic radical nephroureterectomy for upper tract urothelial carcinoma : surgical technique and outcomes. Minerva Urol Nephrol 74 : 233-241, 2022

32） Pizzighella M, et al : The Management of Distal Ureter During Radical Nephroureterectomy Does Not Influence Bladder Recurrence. J Endourol 36 : 77-82, 2022