Gu Qi, Xia Jiadong, Xu Aiming, Zhang Tongtong, Wang Zengjun
Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
Transl Androl Urol. 2020 Dec;9(6):2606-2615. doi: 10.21037/tau-20-1075.
The use of robot-assisted radical cystectomy (RARC) has increased rapidly in the past decade. However, reports of intracorporeal neobladder diversion remain limited. This article aimed to provide the surgical steps for RARC with totally intracorporeal neobladder diversion and the present perioperative, oncologic, and functional outcomes.
Between June 2017 and January 2020, RARC with intracorporeal neobladder diversion was performed in 12 male patients. Perioperative variables, pathologic data, early and late complications, urinary continence, potency, and recurrence-free survival were evaluated as outcome measures.
The surgery was successful in all cases without open conversion. The median operative time, estimated blood loss, and postoperative hospital stay were 419 min (range, 315-640 min), 400 mL (range, 250-1,200 mL), and 14.5 days (range, 9-25 days), respectively. No positive surgical margins nor lymph nodes were observed. Eleven minor (grades 1 and 2) and one major (grades 3-5) complications were found in the early (0-30 days) period and six minor and one major complications in the late (>30 days) period. The median follow-up time was 13.1 months (range, 5.4-32.0 months), and two patients died due to metastatic disease. At 6 months after surgery, the daytime continence rate was 90.0%, while the nighttime continence rate was 80.0%. Only two patients (16.7%) reported capability of potency. The study was limited by a small sample size and short follow-up.
RARC with intracorporeal neobladder is a complex procedure but technically feasible with acceptable oncologic and functional outcomes. Studies with long-term follow ups and increased number of cases and randomized trials are indispensable to assess the potential of this technique.
在过去十年中，机器人辅助根治性膀胱切除术（RARC）的应用迅速增加。然而，关于体内新膀胱改道的报道仍然有限。本文旨在介绍完全体内新膀胱改道的RARC手术步骤以及目前的围手术期、肿瘤学和功能结局。
2017年6月至2020年1月期间，对12例男性患者实施了体内新膀胱改道的RARC手术。评估围手术期变量、病理数据、早期和晚期并发症、尿失禁、性功能和无复发生存率作为结局指标。
所有病例手术均成功，无中转开放手术。中位手术时间、估计失血量和术后住院时间分别为419分钟（范围315 - 640分钟）、400毫升（范围250 - 1200毫升）和14.5天（范围9 - 25天）。未观察到手术切缘阳性和淋巴结转移。早期（0 - 30天）发现11例轻微（1级和2级）并发症和1例严重（3 - 5级）并发症，晚期（>30天）发现6例轻微并发症和1例严重并发症。中位随访时间为13.1个月（范围5.4 - 32.0个月），2例患者因转移性疾病死亡。术后6个月，白天尿失禁率为90.0%，夜间尿失禁率为80.0%。只有2例患者（16.7%）报告有性功能。本研究受样本量小和随访时间短的限制。
体内新膀胱的RARC是一种复杂的手术，但在技术上是可行的，肿瘤学和功能结局可接受。需要长期随访、增加病例数的研究以及随机试验来评估该技术的潜力。
