Abstract:
INTRODUCTION:Nephroureterectomy with excision of a cuff of bladder remains the standard for managing upper tract transitional cell carcinoma (TCC). Increasing use of diagnostic upper tract endoscopy has underlined the importance of obtaining a pre-operative histological diagnosis in order to avoid under-treating high-grade or multifocal disease and over-treating low-grade disease, which could, in selected cases, be managed conservatively. We review nephroureterectomy at our institution over a 10-year period with particular reference to a pre-operative histological diagnosis. PATIENTS AND METHODS:Nephroureterectomy was performed in 113 patients from February 1994 to February 2004. Of these cases, 58 were for upper tract TCC and 50 of these 58 had intravenous urography (IVU): 9 had only IVU, 28 had an additional CT scan, 5 had an additional ultrasonography and 8 had additional CT + ultrasonography for pre-operative work-up. Thirty-four of the 58 cases had retrograde pyelography. Nineteen (32.7%) of the 58 cases had a pre-operative ureteroscopy (URS) and biopsy; 14 of these had rigid URS for tumours in the lower (11) and middle (3) thirds of the ureter and 5 had flexible URS for pelvicalyceal tumours by an experienced endourologist. Thirty-one (53%) of the 58 tumours were within the pelvicalyceal system and 27 within the ureter (upper, 5; middle, 3; lower, 19). Forty-eight patients underwent a total nephroureterectomy: 40 had a two incision approach and 8 had an endoscopic resection of the lower ureter. Five of the 58 cases had a sub-total nephroureterectomy and 5 a laparoscopic nephroureterectomy with open excision of lower ureter. RESULTS:Nineteen (32.7%) of the 58 patients had a pre-operative histological diagnosis - 17 G2pTa, 1 G1pTa, and 1 G2pT1. Fourteen (74%) biopsies matched the final postoperative histology, but 1 was down-staged, 3 up-staged and 1 up-graded compared to the original histology. Five (12.8%) of 39 patients without pre-operative histology had no TCC in the final surgical specimen: 4 (10.25%) had benign pathology such as capillary haemangioma, urothelial cysts and reactive urothelial changes while one had renal cell carcinoma (RCC). CONCLUSIONS:This study underlines the importance of obtaining a pre-operative histological diagnosis in cases with presumed upper tract TCC. Failure to do so can result in unnecessary ablative surgery for benign disease. Such an approach can also help identify multifocality and grade of disease so that treatment of upper tract TCC can be tailored more appropriately with ablative surgery for high-grade or multifocal disease and conservative (endoscopic) therapy for low-grade disease in selected cases. Patients with suspected TCC of the upper tract should be managed at centres where facilities for the comprehensive evaluation of such tumours exist.
journal_name
Ann R Coll Surg Engljournal_title
Annals of the Royal College of Surgeons of Englandauthors
Chitale S,Mbakada R,Irving S,Burgess Ndoi
10.1308/003588408X242268subject
Has Abstractpub_date
2008-01-01 00:00:00pages
45-50issue
1eissn
0035-8843issn
1478-7083journal_volume
90pub_type
杂志文章abstract::Chemotherapy may cause oral ulceration but a thorough investigation of symptoms and signs is important to determine the underlying diagnosis accurately. We describe a case of a patient with a poorly differentiated urothelial carcinoma of the bladder developing a tongue metastasis. This is a challenging diagnosis to ma...
journal_title:Annals of the Royal College of Surgeons of England
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journal_title:Annals of the Royal College of Surgeons of England
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abstract::The three main risk factors for cardiovascular disease, smoking, hypertension, and hyperlipidaemia, are examined in the light of changing world trends and the mechanisms by which they aggravate this large group of conditions. Prostaglandin activity within the vessel wall and the blood platelets may be disturbed by the...
journal_title:Annals of the Royal College of Surgeons of England
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pub_type: 杂志文章,多中心研究
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更新日期:1975-08-01 00:00:00
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journal_title:Annals of the Royal College of Surgeons of England
pub_type: 杂志文章
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更新日期:1989-03-01 00:00:00
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pub_type: 杂志文章
doi:
更新日期:1989-09-01 00:00:00
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更新日期:1996-03-01 00:00:00
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更新日期:1989-09-01 00:00:00
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更新日期:1976-11-01 00:00:00
abstract::Introduction The National Institute for Health and Care Excellence guidance Improving Supportive and Palliative Care for Adults with Cancer (2004) and the Cancer Reform Strategy (2007) support the premise that assessment and discussion of patients' needs for physical, social, psychological, and spiritual wellbeing sho...
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更新日期:2018-03-01 00:00:00
abstract::In the recent Falklands campaign four Army Field Surgical Teams were deployed in the two phases of the war. They functioned as Advanced Surgical Centres and operated on 233 casualties. There were 3 deaths. The patterns of wounding and the methods of casualty management are discussed and compared with other recent camp...
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