Department of Urology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, No. 651 Dongfeng Road East, Guangzhou, 510060, Guangdong, P. R. China.
Cancer Commun (Lond). 2019 Apr 18;39(1):19. doi: 10.1186/s40880-019-0366-8.
Radical cystectomy and urinary diversion remains the standard surgical treatment for patients with muscle-invasive or high-risk or recurrent non-muscle-invasive bladder cancer. Although this approach prolongs patient survival remarkably, there are postoperative complications associated with urinary diversion. This study aimed to assess the efficacy of modified ileal conduit surgery for reducing early and late stoma- and ureteroileal anastomosis-related complications, as compared with conventional ileal conduit urinary diversion.
We retrospectively evaluated the clinical data of bladder cancer patients treated with radical cystectomy and ileal conduit urinary diversion at Sun Yat-sen University Cancer Center between January 1, 2000 and June 30, 2016. Ileal conduit was created by the conventional or a modified technique. The clinicopathologic features of the conventional and the modified ileal conduit groups were compared using the t test and the Chi square test. Multivariable logistic regression analysis and multivariable Cox regression analysis were performed to determine the odds of developing stoma- and ureteroileal anastomosis-related complications in the two groups.
145 and 100 patients underwent the modified and conventional ileal conduit surgery, respectively. The two groups were comparable with regard to clinicopathologic features. The rate of stoma-related complications was significantly lower in the modified ileal conduit group than in the conventional ileal conduit group (0.7% vs. 17.0%, P < 0.001). No late stoma-related complications were seen in the modified ileal conduit group, but were seen in 13 (13.0%) patients in the conventional ileal conduit group. The rate of ureteroileal anastomosis-related complications was significantly lower in the modified ileal conduit group than in the conventional ileal conduit group (4.8% vs. 15.0%, P = 0.001). In multivariable analyses, the modified ileal conduit group was significantly less likely to develop stoma- (odds ratio [OR] = 0.024, 95% confidence interval [CI] 0.003-0.235; P = 0.001) or ureteroileal anastomosis-related complications (OR = 0.141, 95% CI 0.042-0.476; P = 0.002) than the conventional ileal conduit group.
Our modified surgical technique for ileal conduit urinary diversion may be effective for reducing early and late complications related to the stoma and the ureteroileal anastomosis. Prospective randomized clinical trials are needed to confirm our results.
根治性膀胱切除术和尿流改道仍然是肌层浸润性或高危或复发性非肌层浸润性膀胱癌患者的标准手术治疗方法。尽管这种方法显著延长了患者的生存时间，但与尿流改道相关的术后并发症。本研究旨在评估改良回肠导管手术在减少早期和晚期造口和输尿管-回肠吻合口相关并发症方面的疗效，与传统回肠导管尿流改道相比。
我们回顾性评估了中山大学肿瘤防治中心 2000 年 1 月 1 日至 2016 年 6 月 30 日期间接受根治性膀胱切除术和回肠导管尿流改道治疗的膀胱癌患者的临床资料。回肠导管采用传统或改良技术制作。采用 t 检验和卡方检验比较传统回肠导管组和改良回肠导管组的临床病理特征。采用多变量逻辑回归分析和多变量 Cox 回归分析确定两组发生造口和输尿管-回肠吻合口相关并发症的几率。
145 例患者接受改良回肠导管手术，100 例患者接受传统回肠导管手术。两组的临床病理特征无显著差异。改良回肠导管组造口相关并发症发生率明显低于传统回肠导管组（0.7%比 17.0%，P<0.001）。改良回肠导管组未见晚期造口相关并发症，但传统回肠导管组 13 例（13.0%）患者出现该并发症。改良回肠导管组输尿管-回肠吻合口相关并发症发生率明显低于传统回肠导管组（4.8%比 15.0%，P=0.001）。多变量分析显示，改良回肠导管组发生造口（优势比[OR] = 0.024，95%置信区间[CI] 0.003-0.235；P=0.001）或输尿管-回肠吻合口相关并发症（OR=0.141，95%CI 0.042-0.476；P=0.002）的几率明显低于传统回肠导管组。
我们改良的回肠导管尿流改道术可能有效减少造口和输尿管-回肠吻合口相关的早期和晚期并发症。需要前瞻性随机临床试验来证实我们的结果。
