Clinical Research Papers:
Nephroureterectomy increase 5 year survival in patients on dialysis with upper urinary tract urothelial carcinoma
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Cih-En Huang1,2,3, Yao-Hsu Yang4,5,6, Wen-Cheng Chen5,7,8, Kuo-Tsai Huang9, Pau-Chung Chen5,10,11,12, Ying-Huang Tsai13,14 and Wei-Yu Lin3,8,9
1Division of Hematology Oncology, Department of Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
2Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
3Chang Gung University of Science and Technology, Chiayi, Taiwan
4Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan
5Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan
6School of Traditional Chinese Medicine, Chang Gung University, Taoyuan, Taiwan
7Department of Radiation Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan
8College of Medicine, Chang Gung University, Taoyuan, Taiwan
9Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
10Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
11Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan
12Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
13Division of Pulmonary and Critical Care Medicine, Department of Respiratory Care, Chang Gung Memorial Hospital, Chiayi, Taiwan
14Department of Respiratory Therapy, Chang Gung University, Taoyuan, Taiwan
Wei-Yu Lin, email: [email protected]
Keywords: nephroureterectomy, dialysis, elderly, upper tract urothelium carcinoma
Received: May 01, 2017 Accepted: August 02, 2017 Published: August 11, 2017
Background: There is a high incidence rate of upper tract urothelial carcinoma (UTUC) in patients on dialysis. However, the studies about nephroureterectomy (NU) in this high surgical risk group are limited. The aim of this study is to investigate the outcomes of NU in this population.
Results: There were total 931 patients enrolled and 218, 582, 131 patients were non-NU, unilateral and one-stage bilateral NU, respectively. NU provided better 5-year overall survival (66% versus 51% in non-NU, P = 0.001). 19.7% of patients with unilateral NU had successive contralateral NU with a mean interval period of 695 days. Even for the elderly, there were no significant difference in duration of hospitalization, 30- and 90-day mortality between unilateral and bilateral NU.
Materials and Methods: Patients on dialysis with UTUC between January 1998 and December 2012 were assessed from the nationwide cohort of Taiwan National Health Insurance Research Database. We classified these patients into non-NU and NU groups. In NU group, we analyzed clinical outcomes of patient groups between different NU types and surgical methods.
Conclusions: Although the high surgical risk in patients on dialysis with UTUC, NU provided better 5-year overall survival. One-stage bilateral NU both provides comparable safety profile and avoids 19.7% of successive contralateral NU in less than two years. Even in the elderly, one-stage bilateral NU is safe and feasible.
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