Robot-assisted/laparoscopic intracorporeal ileal conduit (ICIC) has been reported in many experienced centers. Whether laparoscopic ICIC is superior to extracorporeal ileal conduit (ECIC) and whether laparoscopic ICIC should be promoted is still controversial. The aim of the study was to compare surgical and early oncological outcomes between patients undergoing laparoscopic radical cystectomy (LRC) with ICIC and ECIC.
From January 2011 to June 2016, a total of 45 patients with bladder cancer underwent LRC with ileal conduit at our department, of whom 20 patients underwent LRC with ECIC and 25 patients underwent LRC with ICIC. Data of each patient's characteristics, surgical outcomes, and short-term oncological outcomes were collected and analyzed.
LRC with ileal conduit was performed successfully on all 45 patients. There were no significant differences in patients' characteristics, mean total operative time, and mean estimated blood loss between the ICIC and ECIC groups. Median time of flatus and oral intake was shorter in the ICIC group compared with the ECIC group (3 vs. 5 days, P = 0.035; 4 vs. 5 days, P = 0.002). The complications rates did not show significant difference between the two groups within the first 90 days postoperatively (P = 0.538). Cancer staging showed 45% of patients in the ECIC group and 36% in the ICIC group had a pathologic stage of T3 or T4, and 50% of patients in the ECIC group and 44% in the ICIC group had a pathologic stage of N1 or N1+. Kaplan-Meier analysis showed no significant difference in overall survival at 24 months (60% vs. 62%, P = 0.857) between the ECIC and ICIC groups.
ICIC after LRC may be successful with the benefits of faster recovery time. No significant difference was found in complications and oncological outcomes between ICIC and ECIC. However, larger series with longer follow-up are needed to validate this procedure.
回顾比较单中心腹腔镜根治性膀胱切除体腔内回肠通道与体腔外回肠通道手术结果及短期肿瘤疗效 摘要 背景： 目前一些大的医疗中心报道了腹腔镜下/机器人辅助根治性膀胱切除+体腔内回肠通道术。腹腔镜下根治性膀胱切除+体腔内回肠通道术是否优于传统体腔外回肠通道术尚没有定论。本研究的目的是比较腹腔镜下根治性膀胱切除之后体腔内回肠通道术与体腔外回肠通道术手术结果及短期肿瘤疗效。方法：从2011年1月到2016年6月，共有45位膀胱癌患者接受了腹腔镜下根治性膀胱切除加回肠通道术，其中前20位患者接受了体腔外回肠通道术，后25位患者接受了体腔内回肠通道术。收集并统计分析患者的一般资料、手术结果数据及短期肿瘤随访结果。结果：所有45例手术均顺利完成。两组患者的一般资料、总手术时间及出血量无统计学差异。体腔内回肠通道组术后排气时间及恢复流食时间均明显缩短（3 vs. 5 天,P= 0.035; 4 vs. 5 天,P= 0.002）。术后90天内并发症未见明显差异（P= 0.538）。在体腔外回肠通道组中，45%的患者病理分期为T3及以上，50%的患者存在淋巴结转移；而体腔内回肠通道组共36%患者在T3及以上，44%患者存在淋巴结转移。Kaplan-Meier分析显示两组术后24月总生存率无明显差异（60% vs. 61.7%, P = 0.857）。结论：腹腔镜下根治性膀胱切除后体腔内回肠通道术可能会加快术后肠道功能恢复，在术后并发症及短期肿瘤疗效方面没有明显差异。然而此研究结论需要大样本长期随访临床试验进一步验证。.
Chinese medical journal. 2018 Apr 05 [Epub]
Ming-Shuai Wang, Qing-Bao He, Fei-Ya Yang, Hao Ping, Nian-Zeng Xing
Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, China.