[Pilot study of laparoscopic radical cystectomy and construction of orthotopic T pouch ileal neobladder].

OBJECTIVE

To summarize the preliminary experiences of 13 cases of laparoscopic radical cystectomy and construction of orthotopic T pouch ileal neobladder and evaluate the oncological and functional outcomes of this procedure.

METHODS

From August 2005 through July 2009, 13 patients underwent radical cystectomy and standard lymphadenectomy followed by construction of orthotopic T pouch ileal neobladder via mini-laparotomy for muscular invasive bladder cancer. The data were analyzed according to procedure time, blood loss volume, transfusion volume, number of dissected lymph nodes, peri-operative complications, morphology and function of upper urinary tract and status of urinary continence.

RESULTS

The mean operating duration was 6 (5 - 8) hours, estimated volume of blood loss 480 (100 - 800) ml, transfusion volume 133 (0 - 400) ml and the number of dissected lymph nodes 16 (8 - 22). There was no peri-operative mortality. The peri-operative complications were found in 15.4% (2/13) and included urine leak at neobladder-urethra junction managed by drainage (n = 1) and urine leak at ureter-neobladder junction repaired (n = 1). The complete daytime continence rate was 84.6% (11/13), complete nocturnal continence rate 46.1% (6/13) and < 1 pad in 30.8% (4/13). No reflux into afferent limb of neobladder was observed by cystography. Temporary dilation of upper urinary tract was observed in 23.1% (3/13) at Day 45 post-operation and later it disappeared spontaneously. Serum creatinine remained in a normal range in all patients. Within a follow-up of 24 (16 - 63) months, 7.7% (1/13) died of myocardial infarction at Month 55 post-operation. And 92.3% (12/13) survived without a local relapse or a distal metastasis.

CONCLUSION

Within an intermediate follow-up period, the oncological and functional outcomes are encouraging after laparoscopic radical cystectomy and construction of orthotopic T pouch ileal neobladder via mini-laparotomy. The anti-reflux mechanism is effective to preserve the morphology and function of upper urinary tract.