Pretreatment neutrophil-to-lymphocyte ratio predicts worse survival outcomes and advanced tumor staging in patients undergoing radical cystectomy for bladder cancer

Objective:To determine the role of neutrophil-to-lymphocyte ratio(NLR)in prognosticating survival outcomes in patients with advanced/metastatic urothelial bladder cancer.Methods:We retrospectively reviewed 84 patients undergoing radical cystectomy(RC)for UCB from January 2002 to June 2012.NLR was computed(median:5 days)prior to surgery.No patients received neoadjuvant chemotherapy.NLR was analyzed as a continuous variable and a cut-off point of 2.7 was obtained,with a statistical receiver operating characteristics of 0.74.KaplaneMeier curves,multivariate Cox proportional hazard and logistics regression models were used to predict NLR association with survival outcomes.Results:The median follow-up period was 30.1 months(range:3.2e161.7)owing to high recurrence rate and subsequent mortalities,compared to the median 64.7 months in patients alive at the end of study period.NLR
2.7 was associated with worse survival outcomes(5-year disease-specific survival:22%vs 58%,p Z 0.017,95%CI:1.193e6.009;5-year overall survival:23%vs 60%,p Z 0.008,95%CI:1.322e6.147).Furthermore,on multivariate analyses,higher NLR was independently associated with higher recurrence rate(p Z 0.007,HR Z6.999,95%CI:1.712e28.606),higher T staging(p Z 0.021,HR Z 3.479,95%CI:1.212e9.990)and lymph node involvement(p Z 0.009,HR Z 4.534,95%CI:1.465e14.034).

Survival after radical cystectomy for bladder cancer:Multicenter comparison between minimally invasive and open approaches

Objective:To investigate oncological outcomes in patients with bladder cancer who underwent minimally invasive radical cystectomy(MIRC)or open radical cystectomy(ORC).Methods:We identified patients with bladder cancer who underwent radical cystectomy(RC)in 13 centers of the Chinese Bladder Cancer Consortium(CBCC).Perioperative outcomes were compared between MIRC and ORC.The influence of surgical approaches on overall survival(OS)and cancer-specific survival(CSS)in the entire study group and subgroups classified according to pathologic stage or lymph node(LN)status was assessed with the log-rank test.Multivariable Cox proportional hazard models were used to evaluate the association among OS,CSS and risk factors of interest.Results:Of 2098 patients who underwent RC,1243 patients underwent MIRC(1087 laparoscopic RC and 156 robotic-assisted RC,respectively),while 855 patients underwent ORC.No significant differences were noted in positive surgical margin rate and 90-day postoperative mortality rate.MIRC was associated with less estimated blood loss,more LN yield,higher rate of neobladder diversion,longer operative time,and longer length of hospital stay.There was no significant difference in OS and CSS according to surgical approaches(pZ0.653,and 0.816,respectively).Subgroup analysis revealed that OS and CSS were not significantly different regardless of the status of extravesical involvement or LN involvement.Multivariable Cox regression analyses showed that the surgical approach was not a significant predictor of OS and CSS.Conclusions:Our study showed that MIRC was comparable to conventional ORC in terms of OS and CSS.

Radical cystectomy for bladder cancer: oncologic outcome in 271 Chinese patients

Few large scale studies have reported the oncologic outcome of radical cystectomy for treating bladder cancer in China; hence, we lack long-term prognostic information. The aim of the current study was to determine the survival rate and prognostic factors of patients who underwent radical cystectomy for bladder cancer in a Chinese medical center. We retrospectively analyzed clinicopathologic data from 271 bladder cancer patients who underwent radical cystectomy between 2000 and 2011. Univariate and multivariate analyses were conducted to identify independent prognostic predictors for this cohort. Median follow-up was 31.7 months(range, 0.2–139.1 months). Thirty-day mortality was(1.4%). The 5-year recurrence-free survival, cancer-specific survival(CSS), and overall survival rates were 61.6%, 72.9%, and 68.0%, respectively. The 5-year CSS rates of patients with T1–T4 disease were 90.7%, 85.0%, 51.0%, and 18.0%, respectively. Patients with organ-confined disease had a higher 5-year CSS rate than those with extravesical disease(81.4% vs. 34.9%, P < 0.001). For the 38 patients(14%) with lymph node involvement, the 5-year CSS rate was 27.7%—significantly lower than that of patients without lymph node metastasis(P < 0.001). The 5-year CSS rate was much higher in patients with low grade tumor than in those with high grade tumor(98.1% vs. 68.1%, P < 0.001). Multivariate Cox regression showed that patient age(hazard ratio, 2.045; P = 0.013) and T category(hazard ratio, 2.213; P < 0.001) were independent predictors for CSS. These results suggest that radical cystectomy is a safe and effective method for treating bladder cancer in Chinese patients. Old age and high T category were associated with poor prognosis in bladder cancer patients who underwent radical cystectomy.

Clinicopathological Analysis of Patients with Nonmuscle-Invasive Bladder Cancer Who Underwent Radical Cystectomy

Objectives: Surgical specimens obtained at the time of the last transurethral resection of bladder tumor (TURBT) for patients with nonmuscle-invasive bladder cancer (NMIBC) who underwent radical cystectomy were retrospectively evaluated in order to investigate the relationship between pathological variation and upstaging of NMIBC. Methods and Materials: Twenty patients (19 men, 1 woman;aged 69.4 ± 12.1 (mean ± SD) years) diagnosed with NMIBC underwent radical cystectomy during follow-up. Results: Five of the 20 patients (25%) had pathological upstaging in the radical cystectomy specimens. There was a statistical association between pathological upstaging and cancer death (p = 0.002). There were three patterns of pathological variation in the upstaged specimens: 1) in patients with BCG-resistant NMIBC, urothelial carcinoma invaded through the lamina propria;2) urothelial carcinoma showed diffuse invasion beyond the deep lamina propria, and the cancer cells had infiltrated as single cells and formed nodules;3) TURBT specimens showed a micropapillary variant. Conclusions: Since these pathological variations correlated with pathological upstaging, they may provide an indication for cystectomy in NMIBC patients.

Laparoscopic Radical Cystectomy in a Low-Middle Income Country: A 5-Year Review of a Single Institution;Operative Data, Oncologic Results and Morbidity

Introduction and Objective: Laparoscopic radical cystectomy (LRC) is an alternative to open approach with lower morbidity and better oncologic outcome. We aim to share our experience on laparoscopic radical cystectomy and to evaluate our morbidity and oncological outcome in our settings. Methodology: An observational study in the Douala Medico-Surgical Urology Centre on 5 patients who underwent laparoscopic cystectomy with or without lymph node dissection and external urine diversion between April 2014 to July 2016 was conducted. The overall survival rate was subsequently estimated. Results: Four men and one woman underwent laparoscopic radical cystectomy during the 5-year study period with a mean age of 54.5-year-old. Three patients were submitted to ileal conduits, one to neobladders, and one patient to uretero-cutaneostomies. The mean operative time was 300 ± 17 minutes and the mean length of hospital stay was 9 ± 3 days. Three patients had minor complications according to Clavien and Dindon Classification treated conservatively without need for further operation. Four patients had transitional cell carcinoma and one Squamous cell carcinoma types. Everyone had negative resection margin while only two had negative lymph node. The median survival years in our study was 2.5 years, the overall survival rates at 2 years were 60%, 40% at 3 years and 20 at 5years. 2 patients die after one year due to renal failure and intercurrent disease. Conclusion: Laparoscopic radical cystectomy carried lower morbidity and cancerological outcome compare to open surgery making it a good alternative for bladder oncologic surgery.

Robtic-assisted radical cystectomy:Literature review

Radical cystectomy(RC)with pelvic lymph node dissection(PLND)is the standard treatment for localized muscle-invasive bladder cancer(MIBC)and non-muscle-invasive bladder cancer(NMIBC)with recurrence or high risk of progression.Also,the robotic approach to this type of surgery is well established in the literature.Our objective is to summarize in this manuscript the most relevant articles related to the robotic-assisted radical cystectomy for prostate cancer.We performed a literature review of articles describing the robotic approach to RC in patients with bladder cancer.Also,we described the procedure since the patient selection until the bladder removal.The reconstructive techniques were not included in this review.Twenty-five articles were used to divide our manuscript into key points such as preoperative patient selection and protocols,surgical technique,pathology report,oncological outcomes,complication rates,and quality of life after the procedure.Robotic-assisted radical cystectomy is feasible and safe with satisfactory oncological outcomes.The robotic approach is related to lower blood loss and fewer transfusion rates.However,when compared to open surgery,the use of this technology increases the operative time.

Efficacy of radical cystectomy plus adjuvant intraarterial chemotherapy with gemcitabine and cisplatin on locally advanced bladder cancer

Background Bladder cancer is the ninth most common cancer in the world; fewer than 15％ of transitional-cell carcinoma patients survive 2 years if left untreated.Although radical cystectomy is the standard treatment of choice,much of them relapse and the necessity of adjuvant chemotherapy is still under debate.The aim of the study was to evaluate the efficacy of adjuvant intraarterial chemotherapy （IAC） with gemcitabine and cisplatin （GC） on locally advanced bladder cancer.Methods This is a retrospective study on 60 patients with locally advanced bladder carcinoma who underwent radical cystectomy between May 2000 and June 2011.Patients were studied in two groups based on IAC and followed up for up to 5 years.Results Among 60 patients,there were 25 patients who underwent IAC （GC） after radical cystectomy （the IAC group） and 35 patients who underwent radical cystectomy alone （the control group）.Although not significant,the relapse rates were slightly reduced in the IAC group than in the control group.Patients with IAC had a reduction in mortality compared with patients without IAC over 5 years.Specifically,IAC significantly reduced about 82％ of mortality within the first year （hazard ratio=0.18,95％ Cl 0.03-0.97,P=-0.04）.Additionally,IAC was well tolerated and safe.The most common adverse effect was transient myelosuppression （10/25,40％）,which was resolved by various medical treatments.Conclusions Compared with radical cystectomy alone,radical cystectomy in combination with adjuvant IAC moderately but significantly reduces 1-year mortality.Our preliminary data showed only marginal benefit for the early survival.However,a randomized clinical study is needed to determine the long-term survival benefit.

Does Postoperative Rehabilitation for Radical Cystectomy Call for Enhanced Recovery after Surgery?A Systematic Review and Metaanalysis

The aim of this review was to systematically compare the outcomes of enhanced recovery after surgery(ERAS)with standard care(SC)after radical cystectomy.We performed a systematic search of PubMed,Ovid?Web of Science,and the Cochrane Library to identify studies published until September 2017 which involved a comparison of ERAS and SC.A meta-analysis was performed to assess the outcomes of ERAS versus SC.Sixteen studies including 8 prospective and 8 retrospective trials met the eligibility criteria.A total of 2100 participants were assigned to ERAS(1258 cases)or SC(842 cases).The time to first flatus passage[WMD=-0.95 days,95%Cl(-1.50,-0.41),P=0.0006],time until return to a regular diet[WMD=-2.15 days,95%Cl(-2.86,—1.45),P<0.00001]and the length of hospital stay[WMD=-3.75 days,95%Cl(-5.13,-2.36),P<0.00001]were significantly shorter,and the incidence of postoperative complications[OR=0.60,95%Cl(0.44,0.83),P=0.002],especially postoperative paralytic ileus[OR=0.43,95%Cl(0.30,0.62),P<0.00001]and cardiovascular complications[OR=0.28,95%Cl(0.09,0.90),P=0.03]was significantly lower in the ERAS group than those in the SC group.This meta-analysis demonstrated that ERAS was associated with a shorter time to first flatus passage,return of bowel fimction,and the length of hospital stay than SC in patients undergoing radical cystectomy,as well as a lower rate of postoperative complications,especially paralytic ileus and cardiovascular complications.

Role of gemcitabine and cisplatin as neoadjuvant chemotherapy in muscle invasive bladder cancer: Experience over the last decade

Objective:Neoadjuvant chemotherapy followed by radical cystectomy is considered the standard of care for patients with muscle invasive bladder cancer.In the last decade,interest in neoadjuvant chemotherapy has slowly shifted from methotrexate,vinblastine,doxorubicin and cisplatin regime to gemcitabine and cisplatin regime.There are many publications on gemcitabine and cisplatin regime in literature which cover different aspects of treatment.This review aims to summarise the findings published so far on gemcitabine and cisplatin regime and present it in a concise manner.Methods:A systematic literature review was conducted searching the PubMed
database in December 2016 using the medical subject heading(MeSH)with the terms gemcitabine,cisplatin,chemotherapy,muscle invasive bladder cancer,and neoadjuvant.All relevant studies were included and results were analysed.Results:A total of 13 studies were included which published between 2007 and 2015.These 13 studies comprised of 754 subjects suffering from muscle invasive bladder cancer.The proportion of male patients ranged from 60%to 86.4%and the median age ranged from 54.2 to 77.3 years in various studies.Complete pathological response(pT0)was seen in 30.0%of patients and pathological downstaging(<pT2)was seen in 48.67%of patients.Conclusion:As per latest guidelines,neoadjuvant chemotherapy is recommended for patients with muscle invasive bladder cancer.There is substantial pathological downstaging with low toxicity in patients of muscle invasive bladder cancer who receive neoadjuvant gemcitabine and cisplatin regime.

Totally intracorporeal robot-assisted urinary diversion for bladder cancer(part 2).Review and detailed characterization of the existing intracorporeal orthotopic ileal neobladder

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.

Totally intracorporeal robot-assisted urinary diversion for bladder cancer(Part 1).Review and detailed characterization of ileal conduit and modified Indiana pouch

Objective:To review the most used robot-assisted cutaneous urinary diversion(CUD)after radical cystectomy for bladder cancer and create a unified compendium of the different alternatives,including new consistent images Methods:A non-systematic review of the literature with the keywords“bladder cancer”,“cutaneous urinary diversion”,and“radical cystectomy”was performed.Results:Twenty-four studies of intracorporeal ileal conduit(ICIC)and two of intracorporeal Indiana pouch(ICIP)were included in the analysis.Regarding ICIC,the patients’age ranged from 60 to 76 years.The operative time to perform a urinary diversion ranged from 60 to 133 min.The total estimated blood loss ranged from 200 to 1117 mL.The rate of positive surgical margins ranged from 0%to 14.3%.Early minor and major complication rates ranged from 0%to 71.4%and from 0%to 53.4%,respectively.Late minor and major complication rates ranged from 0%to 66%and from 0%to 32%,respectively.Totally ICIP data are limited to one case report and one clinical series.Conclusion:The most frequent type of CUD is ICIC.Randomized studies comparing the performance of the different types of CUD,the performance in an intra-or extracorporeal manner,or the performance of a CUD versus orthotopic ileal neobladder are lacking in the literature.To this day,there are not enough quality data to determine the supremacy of one technique.This manuscript represents a compendium of the most used CUD with detailed descriptions of the technical aspects,operative and perioperative outcomes,and new consistent images for each technique.

Transperitoneal Laparoscopic Cystoprostatectomy for Muscle Invasive Bladder Cancer: Results and Oncologic Outcomes in a Single Center in Douala Cameroon

Background and Aim: Radical cystectomy is the treatment of choice for muscle-invasive bladder cancer. Although open surgery is currently the gold standard for this procedure, it can also be done via laparoscopy. We aimed to evaluate the oncologic results and the place of laparoscopic cystectomy in the management of bladder cancer in a single urology center in Douala, Cameroon. Patients and Methods: This is a prospective, single-center study carried out from 2015 to 2019. We included 12 patients (ten men and two women) with bladder cancer who underwent total radical laparoscopic transperitoneal cystectomy with ilio-obturator lymph node dissection. Data on patients’ demographic characteristics, pre-operative and postoperative clinical parameters and workup results, and surgical outcomes were collected to determine the overall survival using a Kaplan-Meier curve. Results: We recruited ten men and two women with a median age of 61.5 [52.8 - 68.5] years. The mean tumor diameter was 3.75 ± 1.06 cm. Three (25%) patients received adjuvant chemotherapy while eight did not. The mean surgery duration was 242 ± 45.85 minutes. Blood vessels and nerves were preserved in four (33.33%) patients during surgery. Transitional cell carcinoma was found in 10 (83.33%) patients while epidermoid carcinoma was found in two (16.67%) patients. Metastasis occurred in four (33.33%) patients while the tumor recurred in two (16.67%) patients who later died. Bricker’s ileal conduit urinary diversion was performed in 10 (83.33%) patients while the Studer neobladder was used in two (16.67%) patients. The mean duration of hospitalization was 6 ± 1.48 days. Only one patient (8.33%) developed a postoperative complication. Six (50%) of the patients died while six survived. The median overall survival was 486 days and the five-year overall survival rate was 46.47%. Conclusion: Laparoscopic cystectomy is a mini-invasive technique associated with good cancer control. When performed by well-trained staff using specialized equipment, it can be a safe and effective method of managing muscle-invasive bladder cancer.

Laparoscopic radical cystectomy with orthotopic ileal neobladder: report of 33 cases

Background The laparoscopic radical cystectomy (LRC) with orthotopic ileal neobladder is now applied to treat invasive bladder cancer, however, it has not been well codified and illustrated We describe in this paper a technique step by step that we have developed in 33 patients and achieved excellent results Methods The surgical procedure can be divided into eight steps: laparoscopic pelvic lymphadenectomy and mobilization of the distal ureters; exposing Denonvillier’s space and the posterior aspect of prostate; exposing retropubic space and anterior surface of the bladder; dividing the lateral pedicles of the bladder and the prostate; dividing the apex of the prostate; extracorporeal formation of the ileal pouch; extracorporeal implantation of the ureters; and laparoscopic urethra neobladder anastomosis This operation was performed in 33 patients, 29 males and 4 females, with muscle invasive bladder cancer between December 2002 and September 2004 Results The operating time was 5 5-8 5 hours with an average of 6 5 hours; the estimated blood loss was 200-1000 ml with an average of 460 ml The surgical margins of the bladder specimen were negative in all patients There was no evidence of local recurrence at follow up of 1-21 months in all the patients However lymph node metastases were found in one case at 9 months postoperatively Most of patients achieved urine control 1 to 3 months after surgery The daytime continence rate was 94% (31 cases) and nighttime continence rate was 88% (29 cases) Urodynamic evaluation was performed between 3 and 6 months postoperatively for all cases The mean value of neobladder capacity was (296±37) ml The mean value of maximum flow rate was (18 7±7 1) ml/s The mean residual urine volume was (32±19) ml In all cases, excretory urography at 1 to 2 months postoperatively demonstrated slightly dilated upper urinary tracts without ureteral obstruction, which resolved at follow up Cystography showed neobladders being similar in shapes to normal Two small ureteral nipples with intermittently efflux of urine were observed at cystoscopy in most patients Postoperative complications occurred in 6 of 33 patients (18%), including pouch leakage in 2 cases, pelvic infection in 1, partial small bowel obstruction in 2 and neobladder vaginal fistula in 1 Conclusions The LRC with orthotopic ileal neobladder is a feasible option for bladder cancer when radical cystectomy is indicated The extracorporeal formation of the ileal pouch and ureteral implantation through a small lower midline incision can simplify the complexity of the procedures, shorten the duration of surgery and reduce the medical expenses

完全腹腔镜膀胱根治性切除回肠膀胱术治疗膀胱癌25例疗效观察

目的探讨完全腹腔镜膀胱根治性切除回肠膀胱术的临床效果和手术技巧,以期为膀胱癌患者手术方式的选择提供参考。方法回顾性分析首都医科大学附属北京朝阳医院泌尿外科2017年3月—2022年8月收治的48例行腹腔镜膀胱根治性切除回肠膀胱术治疗膀胱癌患者的临床资料。按照手术方式分为传统腹腔镜组(腹腔镜膀胱根治性切除+脐下正中切口回肠膀胱术)患者23例,完全腹腔镜组25例。比较两组患者的手术时间、估计出血量、术后肠道功能恢复时间、引流管拔除时间及住院时间。结果48例患者手术均顺利完成,所有患者均未发生Clavien-Dindo>3级并发症。传统腹腔镜组与完全腹腔镜组的手术时间分别为(227.0±46.4)min与(253.6±58.9)min,出血量分别为(131.7±79.8)mL与(154.0±93.0)mL,两组术后肠道功能恢复时间、引流管拔除时间比较差异无统计学意义(P>0.05),而完全腹腔镜组的术后住院时间较传统腹腔镜组更短,差异有统计学意义(P=0.035)。结论完全腹腔镜膀胱根治性切除回肠膀胱术安全可行,与传统腹腔镜手术方式效果相当,而完全腹腔镜组术后住院时间更短,有利于术后快速康复。

普芦卡必利在机器人辅助腹腔镜根治性膀胱切除+尿流改道术围手术期应用的效果分析

目的明确普芦卡必利(PRUC)在机器人辅助腹腔镜根治性膀胱切除(RARC)+尿流改道术围手术期对患者肠道功能的影响。方法回顾性分析2021年4—12月南京大学医学院附属鼓楼医院收治的75例行RARC+尿流改道术(原位膀胱术/回肠膀胱术)患者,根据围手术期是否服用PRUC分为PRUC组(28例)和常规组(47例)。分析比较两组患者术后肠道通气时间、通便时间、引流管留置时间、首次进食半流食物耐受时间、术后住院时间以及术后并发症的发生率,并比较两组患者术后C反应蛋白(CRP)和中性粒细胞/淋巴细胞比值(NLR)的变化。结果PRUC组较常规组患者肠道通气时间和通便时间均更短[(47.14±16.31)h vs.(74.04±35.33)h,P<0.01;(86.14±30.47)h vs.(123.57±79.12)h,P=0.02]。PRUC组较常规组术后CRP(ΔCRP)和NLR变化幅度(ΔNLR)均较小[(79.99±29.71)mg/L vs.(127.75±56.98)mg/L;(9.24±6.43)vs.(16.11±9.90),P均<0.01]。所有并发症均为次要并发症,PRUC组患者术后90 d内肠梗阻发生率有降低的趋势(P=0.38),两组间其他并发症差异均无统计学意义(P>0.05)。结论PRUC可促进RARC+尿流改道术患者术后肠道功能恢复。

基于膜解剖之四纵两横六层面法的腹腔镜根治性膀胱切除术的临床应用价值(“大家泌尿网”观看手术视频)

目的探讨基于膜解剖的四纵两横六层面法的腹腔镜根治性膀胱切除术在膀胱癌治疗中的临床价值。方法回顾性分析暨南大学第一附属医院和第六附属医院泌尿外科2015年1月—2022年6月因膀胱癌行腹腔镜根治性膀胱切除术的51例患者的临床资料,按照“四纵两横六层面法”的手术思路,采用膜解剖技术完成膀胱根治性切除。其中术前性功能正常的男性患者行预先盆神经丛显露的保留性神经的膀胱癌根治术。结果本组患者手术均顺利完成,无中转开放手术。手术时间(502.52±108.99)min,术中失血量(275.96±155.18)mL,术后进食时间(4.14±2.41)d,术后住院时间(16.37±4.85)d,淋巴结清扫数量(17.98±11.48)枚,平均随访(30.27±19.39)个月。在末次随访中,患者均未出现Clavien≥3级的并发症,总体生存率(OS)、肿瘤特异性生存率(TSS)和无复发生存率(RFS)的比率分别为82.4%、92.2%和88.2%。淋巴结阳性和阴性患者的OS分别为60.0%和84.8%、RFS为60.0%和91.3%。行预先显露盆神经丛的保留性神经的膀胱癌根治术患者中18例采用原位新膀胱术,其日间及夜间尿控率分别为83.3%和72.2%,17例在术后6个月内恢复了性功能。结论基于筋膜解剖的四纵两横六层面法腹腔镜膀胱根治性切除术切实可行,手术步骤程序化、肿瘤控制效果好、出血少、术后并发症少、术后恢复快。

术前ALI与行根治性膀胱切除术患者预后的关系

目的:探讨晚期肺癌炎症指数(advanced lung cancer inflammatory index,ALI)与行根治性膀胱切除术(radical cystectomy,RC)患者预后的相关性。方法:分析2012年04月至2021年03月在我院住院行根治性膀胱切除术的115例患者的临床资料,包括基本信息、术前血液学检验、组织病理学及生存情况。采用ROC曲线确定ALI最佳临界值(29.49)并将患者分为低ALI组(46例)和高ALI组(69例),通过Kaplan-Meier法建立生存曲线,Log-Rank检验进行患者总生存期(overall survival,OS)组间比较,Cox回归分析行根治性膀胱切除术患者预后影响因素。结果:共纳入115例患者,男(103例),女(12例);T1期(47例),>T1期(68例);病理级别≤G2(38例),G3(77例);N0期(106例),>N0期(9例)。单因素分析表明ALI、T分期、肿瘤病理级别、N分期、中性粒-淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)、白细胞及中性粒细胞与OS有关,Wald值分别为25.504、22.458、20.013、15.779、22.645、6.098、14.137,均P<0.05。多因素分析表明低ALI(HR=2.387,95%CI为1.085~5.236,Wald=4.673,P<0.05)、T分期(HR=2.796,95%CI为1.381~5.662,Wald=8.163,P<0.01)和肿瘤病理级别(HR=2.907,95%CI为1.315~6.427,Wald=6.949,P<0.01)是患者OS的独立危险因素。术前低ALI组和高ALI组患者中位OS分别为14个月和>50个月,低ALI组患者OS明显低于高ALI组,差异有统计学意义,χ^(2)=29.825,P<0.01。结论:术前低ALI是行根治性膀胱切除术患者OS的独立危险因素,术前ALI可作为行根治性膀胱切除术患者新的预后评估指标。

机器人辅助腹腔镜膀胱癌根治术患者病耻感危险因素分析及护理对策

目的:探讨机器人辅助腹腔镜膀胱癌根治术患者术后早期病耻感及危险因素与护理对策。方法:选取2022年5月—2023年11月武汉市第一医院收治的33例膀胱癌患者。采用问卷法调查行机器人辅助腹腔镜膀胱癌根治术患者的早期病耻感与负性情绪水平。以Pearson相关性分析病耻感与负性情绪的关系,采用线性回归分析病耻感的影响因素。结果:本研究共发放问卷33份,回收有效问卷31份,有效率为93.94%。31例患者术后早期病耻感社会影响量表(SIS)总分为31~94分,平均(63.29±17.97)分;焦虑评分42~67分,平均(53.68±6.36)分;抑郁评分39~71分,平均(56.81±7.17)分。焦虑、抑郁与病耻感SIS总分及各维度评分呈显著正相关(P<0.05)。线性回归分析显示,年龄、受教育程度、居住地、造口接受程度、造口自理程度以及焦虑、抑郁为患者术后病耻感的影响因素(P<0.05)。结论:机器人辅助腹腔镜膀胱癌根治术患者术后早期病耻感与年龄、受教育程度、居住地、造口接受程度、造口自理程度以及焦虑、抑郁密切相关。

根治性膀胱切除术中完整保留女性生殖器官的临床实践

目的探讨根治性膀胱切除术中完整保留女性生殖器官的疗效和技术要点。方法选择2020年和2021年海军军医大学第一附属医院收治的2例拟行根治性膀胱切除术的女性膀胱癌患者,术前评估患者病情,结合患者意愿,术中予完整保留生殖器官,术后定期随访,评估疗效和预后。结果2例患者手术顺利,术后恢复良好,无手术相关并发症。2例患者分别随访22个月、36个月,随访期间均未复发,性功能、生活质量评分均为良好,其中1例患者术后第17个月顺利妊娠,常规产检及无创胎儿DNA检测未见异常。结论在严格把握手术适应证的前提下,根治性膀胱切除术中完整保留女性生殖器官可使患者术后获得更好的生活质量,尤其能保护育龄期女性生育功能。

浸润性膀胱癌患者腹腔镜根治性切除术后回肠新膀胱不同构建方案的效果对比

目的 对比腹腔镜根治性膀胱切除术(RC)后回肠新膀胱不同构建方案在浸润性膀胱癌患者中应用效果。方法 前瞻性纳入124例浸润性膀胱癌患者作为研究对象,按照随机数字表法分为3组。所有患者均行腹腔镜RC,A组行原位U形回肠新膀胱术,B组行原位W形回肠新膀胱术,C组行原位ρ形回肠新膀胱术。采用单因素方差分析比较3组手术情况、术后3个月尿流动力学参数,采用χ^(2)检验比较3组术后近期并发症情况,采用Kruskal-Wallis H检验、χ^(2)检验比较3组患者术后尿控功能恢复情况。结果 B组手术时间较A组、C组长,术中出血量较A组、C组多,差异均有统计学意义(P<0.05);3组排气时间、住院时间比较差异无统计学意义(P>0.05)。3组患者术后近期并发症总发生率比较,差异无统计学意义(P>0.05)。术后3个月,B组新膀胱最大容量最高,其次为A组,C组最低,差异有统计学意义(P<0.05);3组间最大尿流率、初始尿意膀胱容量、新膀胱顺应性、残余尿量比较,差异无统计学意义(P>0.05)。B组术后尿控功能恢复时间最短,其次为C组,A组最长,差异有统计学意义(P<0.05)。结论 腹腔镜RC术后3种不同新膀胱构建方案中U形、ρ形新膀胱手术时间较短,而W形新膀胱手术时间最长、术中出血量最多,但W形术后新膀胱容量最大,术后控尿功能恢复时间最短,3种构建方案术后并发症均较少。