Objective We aimed to compare perioperative and oncologic outcomes for patients undergoing robotic-assisted radical cystectomy(RARC)with intracorporeal ileal conduit(IC)and neobladder(NB)urinary diversion.Methods Pati...Objective We aimed to compare perioperative and oncologic outcomes for patients undergoing robotic-assisted radical cystectomy(RARC)with intracorporeal ileal conduit(IC)and neobladder(NB)urinary diversion.Methods Patients undergoing RARC with intracorporeal urinary diversion between January 2017 and January 2022 at the Icahn School of Medicine at Mount Sinai,New York,NY,USA were indexed.Baseline demographics,clinical characteristics,perioperative,and oncologic outcomes were analyzed.Survival was estimated with Kaplan-Meier plots.Results Of 261 patients(206[78.9%]male),190(72.8%)received IC while 71(27.2%)received NB diversion.Median age was greater in the IC group(71[interquartile range,IQR 65-78]years vs.64[IQR 59-67]years,p<0.001)and BMI was 26.6(IQR 23.2-30.4)kg/m^(2).IC group was more likely to have prior abdominal or pelvic radiation(15.8%vs.2.8%,p=0.014).American Association of Anesthesiologists scores were comparable between groups.The IC group had a higher proportion of patients with pathological tumor stage 2(pT2)tumors(34[17.9%]vs.10[14.1%],p=0.008)and pathological node stages pN2-N3(28[14.7%]vs.3[4.2%],p<0.001).The IC group had less median operative time(272[IQR 246-306]min vs.341[IQR 303-378]min,p<0.001)and estimated blood loss(250[150-500]mL vs.325[200-575]mL,p=0.002).Thirty-and 90-day complication rates were 44.4%and 50.2%,respectively,and comparable between groups.Clavien-Dindo grades 3-5 complications occurred in 27(10.3%)and 34(13.0%)patients within 30 and 90 days,respectively,with comparable rates between groups.Median follow-up was 324(IQR 167-552)days,and comparable between groups.Kaplan-Meier estimate for overall survival at 24 months was 89%for the IC cohort and 93%for the NB cohort(hazard ratio 1.23,95%confidence interval 1.05-2.42,p=0.02).Kaplan-Meier estimate for recurrence-free survival at 24 months was 74%for IC and 87%for NB(hazard ratio 1.81,95%confidence interval 0.82-4.04,p=0.10).Conclusion Patients undergoing intracorporeal IC urinary diversion had higher postoperative cancer stage,increased nodal involvement,similar complications outcomes,decreased overall survival,and similar recurrence-free survival compared to patients undergoing RARC with intracorporeal NB urinary diversion.展开更多
Objective:To review the most used intracorporeal orthotopic ileal neobladder(ICONB)after radical cystectomy for bladder cancer and create a unified compendium of the different alternatives,including new consistent ima...Objective:To review the most used intracorporeal orthotopic ileal neobladder(ICONB)after radical cystectomy for bladder cancer and create a unified compendium of the different alternatives,including new consistent images.Methods:We performed a non-systematic review of the literature with the keywords“bladder cancer”,“urinary diversion”,“radical cystectomy”,and“neobladder”.Results:Forty studies were included in the analysis.The most frequent type of ICONB was the modified Studer“U”neobladder(70%)followed by the Hautmann“W”modified neobladder(7.5%),the“Y”neobladder(5%),and the Padua neobladder(5%).The operative time to perform a urinary diversion ranged from 124 to 553 min.The total estimated blood loss ranged from 200 to 900 mL.The rate of positive surgical margins ranged from 0%to 8.1%.Early minor and major complication rates ranged from 0%to 100%and from 0%to 33%,respectively.Late minor and major complication rates ranged from 0%to 70%and from 0%to 25%,respectively.Conclusion:The most frequent types of ICONB are Studer“U”neobladder,Hautmann“W”neobladder,“Y”neobladder,and the Padua neobladder.Randomized studies comparing the performance of the different types of ICONB,the performance in an intra or extracorporeal manner,or the performance of an ICONB versus ICIC are lacking in the literature.To this day,there are not sufficient quality data to determine the supremacy of one technique.This manuscript represents a compendium of the most used ICONB with detailed descriptions of the technical aspects,operative and perioperative outcomes,and new consistent images of each technique.展开更多
Objective To report the surgical techniques and results of an 8-year follow-up study of 42 patients with a modified orthotopic ileal neobladder restoring normal anatomical relationship. Methods Total cystoprostatecto...Objective To report the surgical techniques and results of an 8-year follow-up study of 42 patients with a modified orthotopic ileal neobladder restoring normal anatomical relationship. Methods Total cystoprostatectomy was performed extraperitoneally. A 45-50 cm segment of the ileal loop was isolated, detubularized, and reconfigured into an “M”-shape to form a pouch. Bilateral ureters were implanted by inserting 1 cm distal segment into the pouch. The bottom of pouch was opened and anastomosed with the urethra. Results Forty-two patients were followed up for 6 to 96 months,90.5% of whom were continent in the daytime, and 85.7% at night. Two patients had a difficulty in urination. The average volume of the pouch was (361±48) ml at 12 months postoperation. Urodynamic examination showed the average peak voiding pressure was (86.8±21.4) cmH 2O. The average maximum flow rate (Qmax) was (18.4±6.1) ml/s. No remarkable ureter reflux and obstruction were found. No patient was detected to have urethral carcinoma.Conclusions Extraperitoneal cystectomy can avoid the tumor contamination of the abdomen and intestinal interference of the operative field. The ureter-inserting implantation technique is a simple anti-reflux anastomosis method with less ureter stenosis rate. Isolating the neobladder and ureters from the peritoneal cavity can reduce the postoperative complications, such as adhesive ileus, internal hernia, and urine leakage into the peritoneal cavity. The neobladder is similar to the original bladder in position, volume, shape and anti-reflux ureter connection.展开更多
目的探讨腹腔镜下保留神经膀胱全切联合抗反流新膀胱重建术的应用价值。方法回顾性分析2016年1月~2019年6月39例膀胱癌行腹腔镜下保留神经的根治性膀胱全切+输尿管与储尿囊抗反流回肠新膀胱构建的资料。男37例,女2例,平均年龄59(47~70)...目的探讨腹腔镜下保留神经膀胱全切联合抗反流新膀胱重建术的应用价值。方法回顾性分析2016年1月~2019年6月39例膀胱癌行腹腔镜下保留神经的根治性膀胱全切+输尿管与储尿囊抗反流回肠新膀胱构建的资料。男37例,女2例,平均年龄59(47~70)岁。采用前列腺筋膜内切除技术(女性保留卵巢、子宫等生殖器官)行膀胱全切,回肠壁瓣联合输尿管拖入吻合抗反流新膀胱构建。随访6个月以上。结果手术均顺利完成。平均手术时间306(260~470)min,其中抗反流新膀胱构建时间43(35~55)min。估计失血量253(150~800)ml。术后平均随访22.5(6~43)月,1例术后33个月肿瘤相关死亡。术后30天内并发症10例(26%),术后30天后并发症3例(8%),均为Clavien-Dindo 1~2级,无膀胱输尿管反流和吻合口狭窄。完全控尿率术后1、6、12个月日间分别为72%(28/39)、97%(38/39)和100%(38/38),夜间分别为54%(21/39)、72%(28/39)和84%(32/38)。37例男性患者术前国际勃起功能指数5(International Index of Erectile Function 5,IIEF-5)得分均≥15,术后6、12个月勃起功能恢复正常(IIEF-5得分≥15)占比分别为46%(17/37)和57%(21/37)。结论腹腔镜下保留神经的根治性膀胱切除+抗反流新膀胱术安全、有效,无严重并发症,短期肿瘤学结果和功能恢复较满意。展开更多
文摘Objective We aimed to compare perioperative and oncologic outcomes for patients undergoing robotic-assisted radical cystectomy(RARC)with intracorporeal ileal conduit(IC)and neobladder(NB)urinary diversion.Methods Patients undergoing RARC with intracorporeal urinary diversion between January 2017 and January 2022 at the Icahn School of Medicine at Mount Sinai,New York,NY,USA were indexed.Baseline demographics,clinical characteristics,perioperative,and oncologic outcomes were analyzed.Survival was estimated with Kaplan-Meier plots.Results Of 261 patients(206[78.9%]male),190(72.8%)received IC while 71(27.2%)received NB diversion.Median age was greater in the IC group(71[interquartile range,IQR 65-78]years vs.64[IQR 59-67]years,p<0.001)and BMI was 26.6(IQR 23.2-30.4)kg/m^(2).IC group was more likely to have prior abdominal or pelvic radiation(15.8%vs.2.8%,p=0.014).American Association of Anesthesiologists scores were comparable between groups.The IC group had a higher proportion of patients with pathological tumor stage 2(pT2)tumors(34[17.9%]vs.10[14.1%],p=0.008)and pathological node stages pN2-N3(28[14.7%]vs.3[4.2%],p<0.001).The IC group had less median operative time(272[IQR 246-306]min vs.341[IQR 303-378]min,p<0.001)and estimated blood loss(250[150-500]mL vs.325[200-575]mL,p=0.002).Thirty-and 90-day complication rates were 44.4%and 50.2%,respectively,and comparable between groups.Clavien-Dindo grades 3-5 complications occurred in 27(10.3%)and 34(13.0%)patients within 30 and 90 days,respectively,with comparable rates between groups.Median follow-up was 324(IQR 167-552)days,and comparable between groups.Kaplan-Meier estimate for overall survival at 24 months was 89%for the IC cohort and 93%for the NB cohort(hazard ratio 1.23,95%confidence interval 1.05-2.42,p=0.02).Kaplan-Meier estimate for recurrence-free survival at 24 months was 74%for IC and 87%for NB(hazard ratio 1.81,95%confidence interval 0.82-4.04,p=0.10).Conclusion Patients undergoing intracorporeal IC urinary diversion had higher postoperative cancer stage,increased nodal involvement,similar complications outcomes,decreased overall survival,and similar recurrence-free survival compared to patients undergoing RARC with intracorporeal NB urinary diversion.
文摘Objective:To review the most used intracorporeal orthotopic ileal neobladder(ICONB)after radical cystectomy for bladder cancer and create a unified compendium of the different alternatives,including new consistent images.Methods:We performed a non-systematic review of the literature with the keywords“bladder cancer”,“urinary diversion”,“radical cystectomy”,and“neobladder”.Results:Forty studies were included in the analysis.The most frequent type of ICONB was the modified Studer“U”neobladder(70%)followed by the Hautmann“W”modified neobladder(7.5%),the“Y”neobladder(5%),and the Padua neobladder(5%).The operative time to perform a urinary diversion ranged from 124 to 553 min.The total estimated blood loss ranged from 200 to 900 mL.The rate of positive surgical margins ranged from 0%to 8.1%.Early minor and major complication rates ranged from 0%to 100%and from 0%to 33%,respectively.Late minor and major complication rates ranged from 0%to 70%and from 0%to 25%,respectively.Conclusion:The most frequent types of ICONB are Studer“U”neobladder,Hautmann“W”neobladder,“Y”neobladder,and the Padua neobladder.Randomized studies comparing the performance of the different types of ICONB,the performance in an intra or extracorporeal manner,or the performance of an ICONB versus ICIC are lacking in the literature.To this day,there are not sufficient quality data to determine the supremacy of one technique.This manuscript represents a compendium of the most used ICONB with detailed descriptions of the technical aspects,operative and perioperative outcomes,and new consistent images of each technique.
基金ThisworkwassupportedbythegrantofScienceandTechnologyofGuangdongProvince (No .962 2 0 5 0 0 1)
文摘Objective To report the surgical techniques and results of an 8-year follow-up study of 42 patients with a modified orthotopic ileal neobladder restoring normal anatomical relationship. Methods Total cystoprostatectomy was performed extraperitoneally. A 45-50 cm segment of the ileal loop was isolated, detubularized, and reconfigured into an “M”-shape to form a pouch. Bilateral ureters were implanted by inserting 1 cm distal segment into the pouch. The bottom of pouch was opened and anastomosed with the urethra. Results Forty-two patients were followed up for 6 to 96 months,90.5% of whom were continent in the daytime, and 85.7% at night. Two patients had a difficulty in urination. The average volume of the pouch was (361±48) ml at 12 months postoperation. Urodynamic examination showed the average peak voiding pressure was (86.8±21.4) cmH 2O. The average maximum flow rate (Qmax) was (18.4±6.1) ml/s. No remarkable ureter reflux and obstruction were found. No patient was detected to have urethral carcinoma.Conclusions Extraperitoneal cystectomy can avoid the tumor contamination of the abdomen and intestinal interference of the operative field. The ureter-inserting implantation technique is a simple anti-reflux anastomosis method with less ureter stenosis rate. Isolating the neobladder and ureters from the peritoneal cavity can reduce the postoperative complications, such as adhesive ileus, internal hernia, and urine leakage into the peritoneal cavity. The neobladder is similar to the original bladder in position, volume, shape and anti-reflux ureter connection.
文摘目的探讨腹腔镜下保留神经膀胱全切联合抗反流新膀胱重建术的应用价值。方法回顾性分析2016年1月~2019年6月39例膀胱癌行腹腔镜下保留神经的根治性膀胱全切+输尿管与储尿囊抗反流回肠新膀胱构建的资料。男37例,女2例,平均年龄59(47~70)岁。采用前列腺筋膜内切除技术(女性保留卵巢、子宫等生殖器官)行膀胱全切,回肠壁瓣联合输尿管拖入吻合抗反流新膀胱构建。随访6个月以上。结果手术均顺利完成。平均手术时间306(260~470)min,其中抗反流新膀胱构建时间43(35~55)min。估计失血量253(150~800)ml。术后平均随访22.5(6~43)月,1例术后33个月肿瘤相关死亡。术后30天内并发症10例(26%),术后30天后并发症3例(8%),均为Clavien-Dindo 1~2级,无膀胱输尿管反流和吻合口狭窄。完全控尿率术后1、6、12个月日间分别为72%(28/39)、97%(38/39)和100%(38/38),夜间分别为54%(21/39)、72%(28/39)和84%(32/38)。37例男性患者术前国际勃起功能指数5(International Index of Erectile Function 5,IIEF-5)得分均≥15,术后6、12个月勃起功能恢复正常(IIEF-5得分≥15)占比分别为46%(17/37)和57%(21/37)。结论腹腔镜下保留神经的根治性膀胱切除+抗反流新膀胱术安全、有效,无严重并发症,短期肿瘤学结果和功能恢复较满意。
