Extraperitoneal radical cystectomy with extraperitonealization of the ileal neobladder: a comparison to the transperitoneal technique.
OBJECTIVE
Transperitoneal radical cystectomy with intraperitoneal ileal neobladder is the standard surgical treatment for muscle-invasive bladder cancer. To reduce morbidity, we established in 2002 an extraperitoneal approach including extraperitonealization of the ileal neobladder. This retrospective study compares the results of the two procedures with a focus on the peri- and postoperative course.


METHODS
Ninety-five male patients with invasive urothelial cancer who underwent radical cystectomy with ileal neobladder at our hospital from January 1998 to May 2007 were analyzed. Forty-seven patients underwent transperitoneal radical cystectomy with intraperitoneal ileal neobladder. The remaining 48 were submitted to the extraperitoneal technique with extraperitonealization of the neobladder. We compared both methods regarding operating time, intraoperative blood loss, complications and oncological outcome.


RESULTS
The incidence of postoperative ileus was significantly lower after the extraperitoneal than after the transperitoneal approach (2/48 vs. 10/47 cases; p = 0.012). However, pelvic lymphoceles were more frequent (6 vs. 0 cases; p = 0.014). The two techniques did not differ with regard to the other major and minor complications, the operating time (mean 377.4 vs. 405.4 min) or the intraoperative blood loss (mean 363 vs. 412 ml). Oncological outcome disclosed no difference between both techniques.


CONCLUSIONS
The extraperitoneal technique with extraperitonealization of the ileal neobladder is comparable in safety and reliability to the transperitoneal surgical approach and yields good peri- and postoperative results with regard to the parameters we examined. Noteworthy are the significant reduction of postoperative ileus and the higher incidence of lymphoceles. Both may be caused by the separate extraperitoneal regional healing processes.
Department of Urology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany. florian.jentzmik@charite.de
Florian
F
Jentzmik
Martin
M
Schostak
Carsten
C
Stephan
Daniel
D
Baumunk
Anja
A
Lingnau
Steffen
S
Weikert
Michael
M
Lein
Kurt
K
Miller
Mark
M
Schrader
D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D039021:Colonic Pouches / Q000706:statistics & numerical data; D015653:Cystectomy / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D045823:Ileus / Q000453:epidemiology; D015994:Incidence; D008197:Lymph Node Excision / Q000706:statistics & numerical data; D008210:Lymphocele / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010537:Peritoneum / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology / Q000601:surgery*