Department of Urology, The Second Affiliated Hospital of Anhui Medical University, Hefei, China.
Internal Medicine, AMITA Health Saint Joseph Hospital, Chicago, Illinois, USA.
J Laparoendosc Adv Surg Tech A. 2022 Jun;32(6):659-667. doi: 10.1089/lap.2021.0519. Epub 2021 Sep 17.
The objective of this study was to compare the perioperative, oncological, and functional results and complications of extracorporeal orthotopic neobladder (EON) and totally intracorporeal orthotopic neobladder (ION) after laparoscopic radical cystectomy (LRC) in patients with muscle-invasive bladder cancer and high-risk nonmuscle-invasive bladder cancer. From January 2013 to October 2019, 152 patients underwent LRC and U-shape neobladder urinary diversion at a single tertiary referral hospital. We then compared the extracorporeal ( = 62) and intracorporeal ( = 90) orthotopic neobladder after laparoscopic cystectomy groups. Of all patients, 90 with ION and 62 with EON were included in the study. Concerning perioperative outcomes, the ION group had lower estimated blood loss (455.7 versus 371.7 mL, = .019), a shorter interval to solid food (6.9 versus 8.7 days, = .006), and a shorter length of hospital stay (14.6 versus 16.0 days, = .009). No statistically significant differences were identified in overall ( = .649), early ( = .509), and late ( = .367) complications. However, in terms of gastrointestinal complications, the ION group had a lower complication rate than the EON group (11.1% versus 27.4%, = .018). There were no statistically significant differences in cancer-specific or noncancer-specific mortality. Daytime and nocturnal continence rates for the ION versus EON groups were 86.7% and 87.1% ( = 1) and 70.0% versus 66.1% ( = .614), respectively. Patients who underwent intracorporeal urinary diversion had a higher health-related quality of life within 3 months postoperative than the extracorporeal urinary diversion group. LRC with ION could be an alternative to EON with similar oncological and functional outcomes at tertiary referral centers. ION had advantages of faster bowel recovery, fewer gastrointestinal complications, and higher quality of life within 3 months postoperative. Clinical Trial Registration No. ChiCTR2100042063.
本研究旨在比较腹腔镜根治性膀胱切除术（LRC）后体外原位新膀胱（EON）和完全体内原位新膀胱（ION）在肌层浸润性膀胱癌和高危非肌层浸润性膀胱癌患者中的围手术期、肿瘤学和功能结果及并发症。2013 年 1 月至 2019 年 10 月，在一家三级转诊医院，有 152 例患者接受了 LRC 和 U 形新膀胱尿流改道术。然后，我们比较了体外（ = 62）和体内（ = 90）新膀胱在腹腔镜膀胱切除术后的情况。所有患者中，90 例接受 ION 手术，62 例接受 EON 手术。关于围手术期结果，ION 组的估计失血量（455.7 与 371.7 mL， = .019）、固体食物恢复时间（6.9 与 8.7 天， = .006）和住院时间（14.6 与 16.0 天， = .009）更短。总体（ = .649）、早期（ = .509）和晚期（ = .367）并发症方面均无统计学差异。然而，在胃肠道并发症方面，ION 组的并发症发生率低于 EON 组（11.1%与 27.4%， = .018）。两组均无癌症特异性或非癌症特异性死亡。ION 组和 EON 组日间和夜间控尿率分别为 86.7%和 87.1%（ = 1）和 70.0%和 66.1%（ = .614）。与体外尿流改道术相比，接受体内尿流改道术的患者在术后 3 个月内的生活质量更高。在三级转诊中心，LRC 联合 ION 可能是 EON 的替代方法，两者具有相似的肿瘤学和功能结果。ION 具有更快的肠道恢复、更少的胃肠道并发症和更高的术后 3 个月内生活质量。临床试验注册号 ChiCTR2100042063。
