Thulium-Holmium:YAG Duo Laser in Conservative Upper Tract Urothelial Cancer Treatment: 13 Years Experience from a Tertiary National Referral Center
| Autor: | Michele Antonucci, Lorenzo Defidio, Mauro De Dominicis, Anup Patel, Gerhard J. Fuchs |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Conservative management Urology Population Lasers Solid-State Conservative Treatment Kidney Nephroureterectomy Disease-Free Survival Tertiary Care Centers Holmium Young Adult Postoperative Complications Ureteroscopy Urothelial cancer Medicine Humans Kidney Pelvis education Urothelial carcinoma Aged Retrospective Studies Aged 80 and over education.field_of_study Carcinoma Transitional Cell business.industry Retrospective cohort study Middle Aged Alternative treatment Kidney Neoplasms Surgery Upper tract Thulium Referral center Female Laser Therapy Neoplasm Recurrence Local business Organ Sparing Treatments |
| Zdroj: | Journal of endourology. 33(11) |
| ISSN: | 1557-900X |
| Popis: | Introduction and Objectives: To evaluate ablative safety and efficacy of thulium-holmium:YAG (TL-HL:YAG) duo laser in renal conserving retrograde intrarenal surgery (RC-RIRS) in upper tract urothelial carcinoma (UTUC). Materials and Methods: A retrospective study was performed on 178 consecutive patients referred for consideration of RC-RIRS UTUC-eLA (endoscopic laser ablation) in a tertiary center (January 2005 to December 2018). Key data were recorded using a standardized study proforma. Results: After endodiagnostic procedure, 42 declined rigorous endosurveillance protocol and went elsewhere for alternative treatment, leaving 136 patients, of whom 35 patients dropped out (25.7%) after undergoing primary radical nephroureterectomy (RNU) (unsuitable for renal preservation). This was left with 101 candidates who continued UTUC conservative management (intention-to-treat [ITT] population). Mean follow-up (FU) for these 101 patients was 28.7 months. At last FU (range 3-144 months), 70 patients (69.3%) were recurrence free, 22 (21.8%) had endoscopically treated recurrences, and a further 9 (8.9%) had undergone RNU. In the ITT population, kidney-preserving rate was 91%, whereas in imperative indications, it was 87.5%. Clavien-Dindo grade I complications only (self-limiting hematuria) were reported in 10%. Conclusions: Over a 13-year period, RC-RIRS UTUC treatment with the TL-HL:YAG duo laser was safe and oncologically noninferior to alternative combination laser energy technologies used for this indication. |
| Databáze: | OpenAIRE |
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