Laparoscopic Radical Cystectomy with Orthotopic Ileal Neobladder:Sun Yat Sen University Experience

Huang Jian, Lin Tianxin, Xu Kewei, Huang Hai, Yao Yousheng et al

Urology Department

The 2nd Affiliated Hospital ,Sun Yat-sen University, Guangzhou China

Laparoscopic radical cystectomy is more and more accepted by doctors and patients.Standard operation procedure has not yet been established.Report our technique improvements of LRC and early results.

The Objectives

Patients data

From Dec.2002 to May 2007 108 cases (96 male, 12 female) All with bladder cancer Follow up: 28 months(1~53 months)

Patients Position

Surgical Procedures:

Pathologcal findings

stageT1 T2 T3 T4a Tis Associated cases 7 66 33 2 3

gradeG1 G2 G3 cases 9 75 24 LN(-): 95 LN(+): 13

TCC 102SCC 3AC 1TCC+AC 2

ResultsThe operation time : 330min 210600minThe blood loss: 320ml501000ml The daytime continence rates: 90.7%The nighttime continence rate: 82.6% The neobladder capacity : 343 ml (230~540ml)

Postoperative IVU

Cystourethrography

Small ureteral nipple in cystoscopy

Post-operative major complicationsvesico-urethral anastomotic leakage 3vesico-urethral anastomotic stricture 2uretero-pouch anastomotic stricture 3Proloned Lymphatic leakage 3 pouch-vaginal fistula 1ileal anastomotic leakage 1colon-pouch fistula 1ileo-pouch fistula 1 pneumonia 1 Pyelonephritis 1 Ileus 3Complication rate 18.5%

Oncological outcomesLocal recurrence 5Trocar site seeding 1Distant metastasis 6 (liver 3, Lung1, bone 2)died 11

discussion

Operation Time2002,Gill: LRCStuder 2 cases 8.5hr and 10.5hrThis group: 5.5hr (3.5~10hr) Pelvic lymphadenectomy 1.5hr Cystectomy 1 hr Neobladder 3hr

Meeting the demand of radical tumor resection or not ?Clearly exposing the pelvic structure, easily identified the anatomy and reduce the rate of positive margin.Standard and extended lymphadenectomy could be accomplished.The recent report of short term showed the survive rate similar to open surgeryLong term effect need to be confirmed.

Postoperative complications ORC complication Steven 23.5% (166 cases Chang 35.8%304 cases LRC Cathelineau 18% 84 cases Haber 8 308 cases this group 18.5% 108 cases

Conclusions Laparoscopic radical cystectomy with extracorporeal formation of neobladder is a feasible procedure with low morbidity and acceptable neobladder function. Long term follow-up is needed to confirm the oncological outcomes.