Pyun Jong Hyun, Kim Hyung Keun, Cho Seok, Kang Sung Gu, Cheon Jun, Lee Jeong Gu, Kim Je Jong, Kang Seok Ho
Department of Urology, Korea University College of Medicine , Seoul, Republic of Korea.
J Laparoendosc Adv Surg Tech A. 2016 May;26(5):349-55. doi: 10.1089/lap.2015.0543. Epub 2016 Feb 23.
To compare the perioperative outcomes, postoperative complications, and early oncologic outcomes of intracorporeal urinary diversion (ICUD) with those of extracorporeal urinary diversion (ECUD) following robot-assisted radical cystectomy (RARC) performed by a single surgeon at a tertiary referral hospital.
We reviewed a prospectively maintained, institutional review board-approved database of 70 patients treated with RARC and pelvic lymph node (LN) dissection for bladder cancer performed from 2007 through 2014. Data were collected for 64 patients who underwent either ICUD or ECUD.
Thirty-eight patients underwent ECUD, and the remaining 26 underwent ICUD. Urinary diversion was performed extracorporeally in the first 37 cases and performed intracorporeally thereafter. There were no significant differences in patient characteristics between the ECUD and ICUD groups. Mean total operative time was 468 minutes for ECUD and 581 minutes for ICUD (P < .05). Mean estimated blood loss was 265 and 148 mL, respectively (P < .05). Minor and total complication rates for patients with the ECUD were higher than in patients with the ICUD (minor: 47.4% vs. 15.4%; total: 57.9% vs. 30.8%; P < .05). All patients showed negative surgical margin, while 21% in the ECUD group and 26.9% in the ICUD group had pathologic stage T3 or T4 (P > .05). The mean LN yield was 23.2 and 31.8, respectively (P < .05).
From our experience, the results show that ICUD after RARC can be successful, with the benefits of decreased blood loss and lower transfusion and complication rates than ECUD. A larger series and long-term follow-up data will be necessary to support our results.
比较在一家三级转诊医院由同一位外科医生实施机器人辅助根治性膀胱切除术（RARC）后，体内尿流改道（ICUD）与体外尿流改道（ECUD）的围手术期结果、术后并发症及早期肿瘤学结果。
我们回顾了一个前瞻性维护、经机构审查委员会批准的数据库，该数据库包含2007年至2014年期间接受RARC及盆腔淋巴结清扫术治疗膀胱癌的70例患者的数据。收集了64例行ICUD或ECUD患者的数据。
38例患者接受了ECUD，其余26例接受了ICUD。前37例患者行体外尿流改道，此后行体内尿流改道。ECUD组和ICUD组患者的特征无显著差异。ECUD组平均总手术时间为468分钟，ICUD组为581分钟（P < 0.05）。平均估计失血量分别为265毫升和148毫升（P < 0.05）。ECUD患者的轻微及总并发症发生率高于ICUD患者（轻微：47.4%对15.4%；总：57.9%对30.8%；P < 0.05）。所有患者手术切缘均为阴性，而ECUD组21%、ICUD组26.9%的患者病理分期为T3或T4（P > 0.05）。平均淋巴结获取数分别为23.2个和31.8个（P < 0.05）。
根据我们的经验，结果表明RARC术后ICUD可以成功，与ECUD相比，具有失血量减少、输血率和并发症发生率较低的优点。需要更大规模的系列研究和长期随访数据来支持我们的结果。
