Diagnosis and Treatment of Renal Pelvis Carcinoma (Report of 92 Cases)

ObjectiveTo discuss the diagnostic and therapeutic methods of renal pelvic carcinoma． MethodsWe retrospectively analyzed the clinical and follow-up data of 92 patients with renal pelvic carcinoma．52 cases were male．Mean age was 64 years ranged from 41 to 82 years. Carcinoma was located at left in 49 cases and right in 43 cases．All patients were treated surgically. 73 cases were open nephroureterectomy with bladder cuff excision (20 cases of T1~2，group A), and 19 cases were nephroureterectomy with of bladder cuff excision using retroperitoneal laparoscopy plus transurethral resection (19 cases of T1~2，group B)． ResultsOne time positive of the urine cytology was 68 cases (73.9%),and three times positive was 29 cases (31.5%). Ratios of final diagnosis of renal pelvic carcinoma by intravenous pyelogram (IVU)，B ultrasound and computed tomography (CT) were 38.6%（32/83）, 78.4%（69/88）and 84.6%（66/78），respectively．The pathological type of 82 cases was transitional cell carcinoma，and of 10 cases was squamous cell carcinoma with transitional cell carcinoma．According to WHO grade, 15 cases was grade Ⅰ，56 cases was grade Ⅱ and 21 cases was gradeⅢ．TNM clinical stages were 55 cases with stage Ⅰ，7 cases with stage Ⅱ 22 cases withstage Ⅲ and8 cases with stageⅣ．100% cases were followed up and mean follow-up time was 38.5 months, ranged from 3 to 60 months．The 3-year and 5-year survival rates of stage Ⅰ～Ⅱ cases were 77.4% and 54.8%，respectively and significantly higher than those of stage Ⅲ～Ⅳ cases (26.7% and 13.3%，respectively), P＜0.05．In group B，blood loss during operation，postoperative drainage, intestinal function，recovery after operation，hospital stay，transfusion and use of anodyne were significantly reduced than those in group A (P＜0.05)，while the tumor size and operating time were no significantly different (P＞0.05) between two groups． ConclusionsHematuria was the most common symptom of renal pelvic carcinoma．Urine cytology，IVU and B ultrasound should be used as a routine examination for renal pelvic carcinoma. Retrograde pyelography or CT might be a useful adjuvant examination when IVU showed negative results．Early diagnosis and treatment of renal pelvic carcinoma were critical for long-term survival．Nephroureterectomy with bladder cuff excision was the preferred treatment，although retroperitoneal laparoscopy plus transurethral resection afforded an improved postoperative course with minimal invasion，fast recovery . The effective cancer control for patient with Ⅰ～Ⅱ stage tumor was similar between 2 surgical methods.