Radical cystectomy in presence of fused "cake" kidney

Radical cystectomy is the optimal treatment for patients with invasive bladder cancer. The presence of a fused pelvic kidney is an uncommon congenital abnormality and when found in a patient with bladder cancer may alter the operative procedure. Herein we report on a patient presenting with invasive bladder cancer and a pelvic "cake" kidney.     

腹腔镜根治性膀胱癌切除术中标准盆腔淋巴结切除的手术改进

目的探讨腹腔镜根治性膀胱癌切除术中标准盆腔淋巴结切除手术方法的改进及疗效。 方法回顾性分析2013年2月至2019年12月,采用自行设计和改进的方法对腹腔镜根治性膀胱切除患者进行标准盆腔淋巴结切除的临床资料。本组145例中,男性133例,女性12例。临床分期T1期9例,T2期105例,T3期31例。 结果所有患者均按改进的手术方法完成了标准盆腔淋巴结切除,术中出血平均25 ml。双侧盆腔淋巴结切除时间35～62 min,平均42 min。清除的淋巴结8～32枚,平均16.3枚。术中术后均未输血。 结论通过对手术方法的优化和改进,可有效的减少标准盆腔淋巴结切除术中的出血,提高盆腔淋巴结切除的彻底性,降低手术的并发症。     

腹腔镜下扩大性膀胱部分切除联合盆腔淋巴结清扫术治疗脐尿管癌

目的 探讨腹腔镜下扩大性膀胱部分切除联合盆腔淋巴结清扫术治疗脐尿管癌的技术要点和临床疗效.方法 脐尿管癌患者4例.男3例,女1例.平均年龄51(42、45、52、66)岁.肿瘤最大径平均3.4(1.9～5.4)cm.其中黏液性腺癌3例,腺癌1例.Sheldon分期Ⅱ期1例,Ⅲ期3例.4例均行经腹腔途径腹腔镜下扩大性膀胱部分切除联合盆腔淋巴结清扫术.手术切除范围包括膀胱顶部、腹横筋膜、脐尿管、脐韧带、腹直肌后鞘、部分腹膜连同肿瘤整块切除及双侧盆腔淋巴结清扫,沿肿瘤周边切除膀胱顶部后装入标本袋取出.结果 4例手术均成功,无中转开放.平均手术时间220(150、180、200、350)min,术中平均出血量180(120、140、170、290)ml,术中损伤腹壁下动脉1例.术后病理报告脐尿管黏液腺癌3例,脐尿管腺癌1例,4例切缘均阴性.4例共清扫淋巴结36枚,均阴性.术后平均留置导尿6(5、5、7、8)d,平均住院6(5、5、8、8)d.术后平均随访25(15、19、29、36)个月,4例均存活,未发现局部肿瘤复发或远处转移.结论 相对于开放手术,腹腔镜下扩大性膀胱部分切除联合双侧盆腔淋巴结清扫术治疗脐尿管癌安全、有效、微创、可行.     

腹腔镜下扩大性膀胱部分切除联合盆腔淋巴结清扫术治疗脐尿管癌

Objective To discuss the techniques and clinical efficacy of laparoscopic partial cystectomy with bilateral pelvic lymphadenectomy for urachal adenocarcinoma. Methods From July 2006 to April 2008, 4 patients with urachal adenocarcinoma were managed by the laparoscopic procedure. Three patients were male, the other one was female, with a median age of 51 (range 42 to 66)years. The mean size of tumors was 3.4(rang 1.9 to 5.4)cm in diameter. Three of them were diagnosed as mucinous adenocarcinoma, the other one was adenocarcinoma. There was 1 patient at stage Ⅱ , and the other three as stage Ⅲ according to Sheldon Stage. Four patients were performed by transperitoneal approach. The boundaries of resection were similar to the open surgery, including resection of the tumor with normal margins, the peritoneum lateral to the two medial unbilical ligaments,the posterior sheath of the rectus muscle and the muscle fibers of the rectus muscle below it, and bilateral pelvic lymphanodes. Results The procedure was successfully in all 4 patients, with a mean operative time of 220(range 150 to 350)min, a mean estimated blood loss of 180 (range 120 to 290)ml.No significant intraoperative or postoperative complications occurred, except for an inferior epigastric artery injury in 1 case. The mean postoperative in-dwelling urinary catheter time was 6 (range 5 to 7)d, and the mean postoperative hospital stay was 6 (range 5 to 8)d. All 36 resected lymph nodes (range 8 to 11) were negative. At a median follow-up of 25(range 15 to 36) months, there was no evidence of recurrent disease by radiologic or cystoscopic evaluation. Conclusion Laparoscopic partial cystectomy and bilateral extended pelvic lymphadenectomy in selected patients with urachal tumors could be a safe, feasible, minimally invasive procedure.     

腹腔镜下扩大性膀胱部分切除联合盆腔淋巴结清扫术治疗脐尿管癌

Objective To discuss the techniques and clinical efficacy of laparoscopic partial cystectomy with bilateral pelvic lymphadenectomy for urachal adenocarcinoma. Methods From July 2006 to April 2008, 4 patients with urachal adenocarcinoma were managed by the laparoscopic procedure. Three patients were male, the other one was female, with a median age of 51 (range 42 to 66)years. The mean size of tumors was 3.4(rang 1.9 to 5.4)cm in diameter. Three of them were diagnosed as mucinous adenocarcinoma, the other one was adenocarcinoma. There was 1 patient at stage Ⅱ , and the other three as stage Ⅲ according to Sheldon Stage. Four patients were performed by transperitoneal approach. The boundaries of resection were similar to the open surgery, including resection of the tumor with normal margins, the peritoneum lateral to the two medial unbilical ligaments,the posterior sheath of the rectus muscle and the muscle fibers of the rectus muscle below it, and bilateral pelvic lymphanodes. Results The procedure was successfully in all 4 patients, with a mean operative time of 220(range 150 to 350)min, a mean estimated blood loss of 180 (range 120 to 290)ml.No significant intraoperative or postoperative complications occurred, except for an inferior epigastric artery injury in 1 case. The mean postoperative in-dwelling urinary catheter time was 6 (range 5 to 7)d, and the mean postoperative hospital stay was 6 (range 5 to 8)d. All 36 resected lymph nodes (range 8 to 11) were negative. At a median follow-up of 25(range 15 to 36) months, there was no evidence of recurrent disease by radiologic or cystoscopic evaluation. Conclusion Laparoscopic partial cystectomy and bilateral extended pelvic lymphadenectomy in selected patients with urachal tumors could be a safe, feasible, minimally invasive procedure.     

Radical cystectomy with extended lymphadenectomy: evaluating separate package versus en bloc submission for node positive bladder cancer

PURPOSE: To provide future mapping analysis of lymph node positive disease we modified our lymphadenectomy at radical cystectomy for bladder cancer from an en bloc packet to 13 separate nodal packets. We evaluated the clinical and pathological findings resulting from this modification. MATERIALS AND METHODS: A total of 1,359 patients underwent en bloc radical cystectomy and extended lymphadenectomy for bladder cancer. They were compared to 262 patients who underwent radical cystectomy and extended lymphadenectomy with lymph nodes submitted in 13 distinct nodal packets. Overall 317 patients (23%) of the en bloc group (group 1) and 66 of the 262 (25%) in the separately packaged group (group 2) had node positive disease. Clinical and pathological findings were analyzed to compare these 2 groups of patients. RESULTS: Although the incidence of lymph node positivity was not different, the median number of total lymph nodes removed in group 2 was significantly higher than that in group 1 (68, range 14 to 132 vs 31, range 1 to 96, p<0.001). A trend toward more lymph nodes involved was observed in group 2 compared to group 1 (3, range 1 to 91 vs 2, range 1 to 63, p=0.062). These findings significantly lowered median lymph node density in group 2 compared to that in group 1 (6% vs 9%, p=0.006). CONCLUSIONS: Although the overall incidence of lymph node positive disease was not different, the submission of 13 separate nodal packets at radical cystectomy significantly increased the total number of lymph nodes removed/analyzed and identified a slightly higher number of positive lymph nodes compared to en bloc submission.     

Significance of pelvic lymphadenectomy for the prognosis after radical cystectomy

OBJECTIVE: In contrast to other carcinomas such as breast or colon cancer, there are no guidelines regarding the number and location of lymph nodes to be removed during radical surgery in patients with invasive bladder carcinoma. The therapeutic effect of pelvic lymphadenectomy and its influence on tumour staging has not been documented yet. METHODS: Here we present an evaluation of pelvic lymph nodes from 484 patients who underwent radical cystectomy with curative intention between 1986 and 1999. The number of lymph nodes was correlated with the depth of invasion of the primary tumour, occurrence of nodal metastases, clinical outcome, the operating surgeon, and the pathologist. RESULTS: There were 484 patients with a mean age of 62.7 years. Clinical follow up was available from 321 patients with a mean follow up period of 35.9 months. The average number of lymph nodes removed was 14.3 (range: 1-46). The number of lymph nodes removed varied significantly between different surgeons and did not correlate with the pathologists. There was a significant correlation between the number of lymph nodes removed and the tumour-free survival in pT2 or pT3 tumours and in patients without lymph node metastases. Multivariate analysis revealed that pT-category (p < 0.01), pN-category (p < 0.01), and the total number of lymph nodes removed (p = 0.04) were the most important factors affecting survival. CONCLUSION: The more extensive lymphadenectomy significantly improved the prognosis of patients with invasive bladder cancer and therefore, represents a potentially curative procedure. The results indicate a need for a standardised lymph node dissection.     

Radical prostatectomy in the presence of pelvic lipomatosis

Pelvic lipomatosis may increase significantly the difficulty and morbidity of many urologic procedures. Radical prostatectomy in this setting has not been described previously. Such a case is presented and the reported surgical experience in pelvic lipomatosis is reviewed. Considerations in the management of prostatic cancer in patients with this condition are discussed.     

Robotic extended pelvic lymphadenectomy for bladder cancer with increased nodal yield

Study Type – Therapy (case series)
Level of Evidence 4 What’s known on the subject? and What does the study add? The standard of care for invasive bladder cancer is open radical cystectomy with the extent of pelvic lymph node dissection impacting oncological outcomes. Scepticism remains regarding whether an adequate node dissection can be performed in minimally‐invasive fashion as previously reported nodal yields of laparoscopic or robotic lymphadenectomy are well below those reported with open surgery. This study demonstrates that extended pelvic lymphadenectomy can be performed robotically with equivalent nodal yields to open series from centres of excellence.

OBJECTIVE

? To report our initial experience with robot‐assisted extended pelvic lymph node dissection (ePLND) using a standardized open template.

PATIENTS AND METHODS

? In total, 15 consecutive patients underwent robotic radical cystectomy at a single center by a single surgeon using a standard dissection template. ? Operating time, time to perform ePLND, pathological stage, estimated blood loss, length of hospital stay, number of nodes obtained and nodal positivity were assessed. Postoperative complications and re‐admissions were reviewed.

RESULTS

? The mean (range) age and body mass index was 66 (46–87) years and 29 (22–43) kg/m², respectively. The mean (range) operating time and ePLND time was 423 (300–506) min and 107 (66–160) min. Mean (range) estimated blood loss was 160 (50–500) mL. ? The mean (range) and median length of hospital stay were 3.4 (3–7) days and 3 days, respectively. The mean (range) nodal yield was 41.8 (18–67) nodes, with greater than 25 nodes in 13 patients. ? Three patients were found to have nodal positivity. Of the fifteen patients, four received neoadjuvant chemotherapy. Two patients were re‐admitted for postoperative complications within 30 days. ? There were no complications directly resulting from the ePLND.

CONCLUSIONS

? Robot‐assisted ePLND at the time of cystectomy can be safely and effectively performed on the robotic platform with comparable nodal yields to open series at centers of excellence for cystectomy. ? Nodal yields are likely to comprise a factor related to the effort of the surgeon, and not the method by which the lymphadenectomy is performed.     

腹腔镜下膀胱全切除前后施行盆腔淋巴结清扫术的疗效对比

目的:对比分析腹腔镜下膀胱全切前、后施行盆腔淋巴结清扫术的临床疗效。方法:选取2014年7月至2016年7月行腹腔镜下膀胱全切术+盆腔淋巴结清扫术的120例男性膀胱癌患者作为研究对象,通过随机数字表法分为两组,A组(n=60)于腹腔镜膀胱全切术前行盆腔淋巴结清扫术,B组(n=60)于腹腔镜膀胱全切术后行盆腔淋巴结清扫术。对比分析两组手术时间、清扫效果及并发症发生情况。结果:两组盆腔淋巴结清扫时间差异无统计学意义,A组膀胱全切术时间短于B组,差异有统计学意义(P<0.05)。A组髂内、髂前及骶前淋巴结清扫数量少于B组,差异有统计学意义(P<0.05)。两组髂外、闭孔、腹膜后淋巴结清扫数量差异无统计学意义(P>0.05)。A组淋巴结清扫总数少于B组,差异有统计学意义(P<0.05)。两组并发症总发生率(21.7%vs. 23.3%)差异无统计学意义(P>0.05)。结论:腹腔镜下膀胱全切术前行盆腔淋巴结清扫术的手术时间较短,但淋巴结清扫数量较少,膀胱切除术后需再次对髂前、髂内淋巴结进行核查并行补充清扫。     

腹腔镜根治性膀胱切除术中盆腔淋巴结清扫的技术改进

目的介绍腹腔镜根治性膀胱切除术中盆腔淋巴结清扫的手术方法改进及其疗效。方法2002年12月至2007年12月我院施行了129例膀胱癌腹腔镜盆腔淋巴结清扫术。本组男性111例,女性18例。手术技巧的改良分为早期探索阶段和技术标准化阶段。早期探索阶段（25例）：尝试不同器械、不同手术次序、不同手术技巧的淋巴结清扫方法;技术标准化阶段（104例）：采用吸引器、电凝钩及血管闭合器（LigaSure）相结合的方法,按标准化的手术次序进行盆腔淋巴结清扫,其中13例施行扩大淋巴结清扫。结果全部病例盆腔淋巴结清扫术在腹腔镜下顺利完成。技术标准化阶段完成双侧标准盆腔淋巴结清扫术（91例）时间（76．1±17．8）min,出血量（62．6±30．7）ml,术中损伤髂外静脉（1．1％,1／91）,术后淋巴漏发生率（2．2％,2／91）,与早期探索阶段相比较,手术时间缩短、出血量减少、并发症减少。术后随诊1～5年,无继发出血,无下肢淋巴水肿,8例出现局部复发,6例发生远处转移。结论采用吸引器、电凝钩及LigaSure相结合的改良方法行腹腔镜盆腔淋巴结清扫术能减少术中并发症,缩短手术时间,减少术后淋巴漏,肿瘤控制效果满意。     

Pelvic lymphadenectomy and radical cystectomy for transitional cell carcinoma of the bladder with pelvic nodal disease

Past and present methods of treatment for patients with stage D1 (T1-4 N+ MO) transitional cell cancer of the urinary bladder have proved to be largely ineffective. This report on 57 patients with stage D1 disease confirms this impression and demonstrates that radical operation alone is associated with a 5-year survival rate of only 10%. Survival is related to tumour grade and to the number of pelvic lymph nodes involved; furthermore, complete lymphadenectomy may contribute to improved patient survival. Effective treatment programmes for stage D1 bladder cancer are lacking and efforts should be directed toward developing treatment protocols that combine radical cystectomy and meticulous pelvic node dissection with an effective adjuvant systemic treatment programme.