李瑋涓¹、黃志平^{1, 2}、張兆祥¹、楊啟瑞¹、吳錫金^{2, 3}

中國醫藥大學附設醫院 ¹泌尿部；²中國醫藥大學 醫學系 泌尿學科；³中國醫藥大學附設醫院北港分院 泌尿部

Wei-Juan Li¹, Chi-Ping Huang^1,2, Chao-Hsiang Chang¹,Chi-Rei Yang¹, Hsi-Chin Wu^2,3

¹Department of Urology, China Medical University Hospital, Taichung, Taiwan

²School of Medicine, China Medical University, Taichung, Taiwan

³Department of Urology, China Medical University Beigang Hospital, Beigang, Yunlin, Taiwan

 

Radical cystectomy (RC) remains the gold standard treatment for muscle‐invasive bladder cancer (MIBC). For the patients who are eligible for ileal neo-bladder reconstruction, robotic approach with intracorporeal reconstruction was considered a minimal-invasive but technically challenging surgery. As to evaluate the outcomes of robotic radical cystectomy with intracorporeal neo-bladder reconstruction, this study retrospectively reviewed a single center experience as case series.

We retrospectively reviewed 5 cases who received robotic radical cystectomy with intracorporeal neo-bladder reconstruction between June 2014 and November 2018. Demographic, perioperative data and postoperative outcomes were collected and statistically analyzed.

A total of four men and one women with mean age 50-years-old, body weight mass (BMI) 24.4 (range, 19.7 to 30.4) kg/m² and Eastern Cooperative Oncology Group (ECOG) 1 underwent robotic radical cystectomy with intracorporeal neo-bladder reconstruction. There were two preoperative T2 staging and three T3 staging with all high grade bladder cancer. All of them received neoadjuvant chemotherapy. The mean operative time was 622 min (range, 500 to 830) and blood loss was 290 ml (100 to 700). The mean hospital stay was 13.2 (8 to 23) days with no open conversion. One grade II perioperative complications who had systemic lupus erythematosus (SLE) with long-term steroid use and developed pneumonia after operation. The postoperative staging was T0N0, T1N0, T2aN0, T3aN0 and T4bN2 separately and positive margins were only found in the last patient. The female patient with child-bearing age received genital sparing radical cystectomy and no recurrence till the end of the study. The T4 patient received salvage chemotherapy and immune checkpoint inhibitors pembrolizumab and encountered immune-related adverse events of gastrointestinal toxicities with small intestine perforation then mortality. The 120-day mortality rates were 0%. The average follow-up was 16.6 months (4 to 57). Continence was achieved in all patients. The cancer-specific survival rate and overall survival rate were 100% and 80%, respectively.

Robotic radical cystectomy with intracorporeal reconstruction is a feasible surgery with acceptable operative time and few complications. Larger case group and longer follow-up were necessary for further study.