Wei Houyi, Wang Mingshuai, Wasilijiang Wahafu, Wang Wei, Guan Xing, Zhou Xiaoguang, Song Liming, Xing Nianzeng, Niu Yinong
Institute of Urology, Capital Medical University, Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
Department of Urology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Transl Androl Urol. 2021 Apr;10(4):1596-1606. doi: 10.21037/tau-20-1515.
This study introduces the results of laparoscopic radical cystectomy with modified intracorporeal ileal conduit (mICIC), which was accompanied by enhanced recovery after surgery (ERAS) protocols.
From March 2014 to June 2020, 48 patients underwent mICIC. Patients were divided into ERAS (n=17) and non-ERAS groups (n=31). Baseline and perioperative variables were analyzed. The primary outcome was 90-day complications. Secondary outcomes were operative time, length of stay, two-year overall survival, cancer-specific survival, and disease-free survival.
Forty-eight patients underwent intracorporeal ileal conduit with no transition to open surgery. Twenty-five patients (52.1%) experienced at least one complication, including 22 minor cases (45.8%) and three major cases (6.2%). The median operative time, urinary diversion time, estimated blood loss, and length of stay were 320 min, 135 min, 200 mL, and 10.5 days, respectively. The median time to flatus and normal diet were two days and three days, respectively. A comparison between ERAS and non-ERAS groups indicated that ERAS implementation was associated with less complications (29.4% 64.5%, P=0.018), faster time to flatus (2 3 days, P=0.016) and liquid diet (2 4 days, P<0.001). The results of hydronephrosis and compromised renal function showed no difference between the preoperative period and six months after surgery. The mean follow-up time was 25.4 months, and the two-year overall survival, cancer-specific survival, and disease-free survival rates were 61.3%, 73.2%, and 58.4%, respectively.
The complication rate and operative time of the mICIC were acceptable. Clinical outcomes can be optimized with ERAS pathway.
本研究介绍了采用改良体内回肠代膀胱术（mICIC）的腹腔镜根治性膀胱切除术的结果，该手术采用了加速康复外科（ERAS）方案。
2014年3月至2020年6月，48例患者接受了mICIC手术。患者分为ERAS组（n = 17）和非ERAS组（n = 31）。分析了基线和围手术期变量。主要结局为90天并发症。次要结局为手术时间、住院时间、两年总生存率、癌症特异性生存率和无病生存率。
48例患者接受了体内回肠代膀胱术，无一例转为开放手术。25例患者（52.1%）至少发生一种并发症，包括22例轻微并发症（45.8%）和3例严重并发症（6.2%）。中位手术时间、尿流改道时间、估计失血量和住院时间分别为320分钟、135分钟、200毫升和10.5天。排气和正常饮食的中位时间分别为两天和三天。ERAS组与非ERAS组的比较表明，实施ERAS与较少的并发症（29.4%对64.5%，P = 0.018）、更快的排气时间（2天对3天，P = 0.016）和流食时间（2天对4天，P < 0.001）相关。肾盂积水和肾功能受损的结果在术前和术后六个月之间无差异。平均随访时间为25.4个月，两年总生存率、癌症特异性生存率和无病生存率分别为61.3%、73.2%和58.4%。
mICIC的并发症发生率和手术时间是可以接受的。采用ERAS路径可优化临床结局。
