臺中榮民總醫院 外科部 泌尿外科
Comparison with open conventional laparoscopic and robotic assisted laparoscopic radical cystectomy with urinary diversion method— 3 years experience of single team
Cheng-Kuang Yang , Yen-Chuan Ou.
Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan
Purpose: Open radical cystectomy with urinary diversion is gold standard management for invasive bladder cancer. Minimal invasive radical cystectomy had been developed for more than ten years. We describe our 3 years experience of conventional laparoscopic radical cystectomy(LRC) with extracorporeal urinary diversion via 3cm wound incisions. We performed robotic assisted laparoscopic radical cystectomy (RaLRC) with intracoporeal urinary diversion in the past 12 months.In this study, We aim to compare the perioperative outcomes of these two different minimalinvasive approaches to open radical cystectomy
Materials and Methods: From January 2011 to Dec 2014, 10 open cystectomy, 28 consecutive patients underwent conventional laparoscopic radical cystectomy with extracoporeal urinary diversion, 17 patients underwent robotic assisted laparoscopic radical cystectomy (RaLRC) with 8 cases of intracoporeal and 9 cases of extracoporeal urinary diversion by a single surgical team. Perioperative outcome include operative time ( lymph node dissection with cystectomy time, urinary diversion time ), blood loss, time to return to diet , one month complication rate and length of hospital stay. Oncological outcome included dissected lymph node numbers , LN positive rate, postive surgical margin and 1 year disease free survival rate.
Results: There is no significant differences in estimated blood loss,blood transfusion rate and ileus rate between these two minmal invasive groups, but greater in open cystectomy group. Besides there were no significant differences in time toreturn to diet, pain score, pathological stage and positive surgical margin rate between three groups. Similar operative time for lymph node dissection with radical cystectomy in two minimal invasive groups.( Mean time: 164.6 minutes for LRC and 148.2 for RaLRC) Shorter operative time for extracorporeal urinary diversion ( Extracorporeal ileal conduit : 72.3 minutes, Extracorporeal neobladder : 108.7 minutes, intracorporeal ileal conduit : 175.8 minutes and intracorporeal neobladder : 249.3 minutes) Average dissected LN numbers are 24.6 in ORC, 34.5 in LRC and 42.8 in RaLRC. There was no perioperative bowel injury in these three groups. No ureteral complication in extracorporeal urinary diversion group, but 3 ureteral complication withl urine leakage in intracorporeal group.The 1-year disease free survival rate was 92.7% in the LRC group and the 1-year overall survival rates were both 100%. .
Conclusions: Our experience shows that minimal invasive radical cystectomy with extracorporeal urinary diversion via small incisions is a safe and feasible surgical technique with acceptable perioperative results. RaLRC seemed more precisely in lymph node dissection and cystectomies,but long operative time and more urinary complications in intracorporeal urinary diversion. We try to step over the learning curve of intracorporeal urinary diversion, besides more convincing results with a longer follow-up period and large number of cases are necessary to validate our findings.