Pure intracorporeal laparoscopic radical cystectomy with orthotopic "U" shaped ileal neobladder.
BACKGROUND
Radical cystectomy with pelvic lymph node dissection represents the standard treatment for muscle-invasive, and high-risk non-muscle-invasive bladder cancers. Aim of this study was to report our case series of 30 patients undergoing totally laparoscopic radical cystectomy (LRC) with reconstruction of an intracorporeal orthotopic ileal neobladder. Intra- and perioperative results and the functional and oncological outcomes 9 months after operation are reported.


METHODS
Between October 2010 and December 2012, 30 male patients underwent LRC with a pure laparoscopic orthotopic ileal "U"- shaped neobladder diversion. The men had a median age of 67 years, a median body mass index of 22.3, and a mean ASA score of 2.2; they represented various clinical stages of disease.


RESULTS
None of the patients required conversion to open surgery, and no perioperative mortalities were reported. The median operating time was 365 min, and the median blood loss was 290 mL, with a transfusion rate of 26.6%. All surgical margins were negative; 8 patients with non-organ-confined disease or positive lymph nodes received adjuvant chemotherapy. Early complications (within 30 days) occurred in 7 patients, and late complications occurred in 6 patients. The mean hospital stay was 9 days. At 9 months after surgery, the daytime continence rate was 83.3% and the nighttime continence rate was 73.3%.


CONCLUSIONS
Pure LRC with intracorporeal orthotopic ileal neobladder reconstruction may represent a viable alternative to open radical cystectomy, with a significant reduction in patient morbidity. Future, large, randomized controlled trials with extensive follow-up are needed to confirm our encouraging results.
Department of Medico-Surgical Sciences and Biotechnologies, Faculty of Pharmacy and Medicine, Urology Unit ICOT, Sapienza University of Rome, Via Franco Faggiana 1668, Latina 04100, Italy. antopast@hotmail.com.
Antonio Luigi
AL
Pastore
Giovanni
G
Palleschi
Luigi
L
Silvestri
Giuseppe
G
Cavallaro
Mario
M
Rizzello
Gianfranco
G
Silecchia
Cosimo
C
de Nunzio
Samer Fathi
SF
Al-Rawashdah
Vincenzo
V
Petrozza
Antonio
A
Carbone
D000368:Aged; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007082:Ileum / Q000637:transplantation*; D007902:Length of Stay; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects / Q000379:methods*; D016476:Urinary Reservoirs, Continent