Transitional cell carcinoma of ileal loop following cystectomy

This is the second case reported in the literature involving transitional cell carcinoma in an ileal loop. The case is described and the literature reviewed.     

Transitional cell carcinoma relapse in uretero-ileal conduit after radical cystectomy

Transitional cell carcinoma relapse in ileal conduit after radical cistectomy is a rare event, especially without upper urinary tract involvement. We describe a case of uretero-ileal transitional cell tumour five years after cistectomy for invasive urothelial tumour. Patient underwent endoscopic treatment with good results after 13 months of follow-up.     

Metastatic transitional cell carcinoma in an ileal conduit following cystectomy

We report a case of recurrent transitional cell carcinoma involving an ileal conduit. The patient presented with a febrile urinary tract infection and upper tract obstruction. This is the third case reported of such a tumor occurring in the absence of upper tract malignancy. The literature is reviewed.     

Effect of ileal conduit on patients' activities following radical cystectomy

Over the last twenty months, 110 patients who have undergone a radical cystectomy for bladder cancer at The University of Texas M. D. Anderson Cancer Center were surveyed to assess the effect of an ileal conduit urinary diversion on postoperative activity. Postoperatively, 47.3 percent of the patients were very active, 34.5 percent were moderately active, and 18.2 percent were sedentary. Chemotherapy and the patient's gender were found to have a statistically significant effect on postoperative activity level. Chemotherapy resulted in a decrease of very active patients from 55.6 percent to 27.9 percent and an increase in sedentary patients from 11.2 percent to 30.2 percent (P = 0.005). No difference in activity levels was seen in 73.9 percent of the nonchemotherapy patients. Fifty-one percent of the men were very active as compared with only 19.1 percent of the women, whereas 20 percent more women than men were moderately active and 13 percent more were sedentary. Our experience indicates that the ileal conduit had no significant negative effect on activity if the effects of chemotherapy are controlled: 82.6 percent of the patients not receiving chemotherapy experienced either no change or an increase in their activity.     

腹腔镜膀胱癌根治加回肠膀胱术

目的:总结腹腔镜下膀胱癌根治加回肠膀胱术的手术方法及临床疗效。方法:2003年6月～2007年5月共行25例腹腔镜下根治性全膀胱切除、双侧盆腔淋巴结清扫加回肠膀胱术,患者平均年龄68岁,全膀胱切除和盆腔淋巴结清扫均在腹腔镜下完成,标本自下腹部小切口取出后,体外切取末端回肠10～15cm,近端闭合并与双侧输尿管吻合,远端造口于右下腹壁。结果:所有手术均顺利完成,手术时间210～320min,平均270min。术中出血220～1000ml,平均460ml。平均每例清扫淋巴结数10个,淋巴结阳性率16.2%,手术切缘均阴性。术后3～5天肠道功能恢复,1例因粘连性肠梗阻于术后1周再行手术探查松解粘连。术后2～3周拔除单J管,无肠漏及尿漏并发症发生。随访2～30个月,1例死于原发病转移,无腹壁造口狭窄发生,3例术后B超或造影显示单侧轻度肾积水和轻度输尿管扩张。结论:腹腔镜膀胱癌根治术具有创伤小,恢复快等优点,但手术难度较大,手术技术要求较高。回肠膀胱术手术操作相对简单,并发症少,可作为腹腔镜膀胱癌根治术后尿流改道可选方式之一。     

Urinary diversion following radical cystectomy: ileal conduit or ileal replacement bladder?

Among those patients who have undergone radical cystoprostatectomy in the Department of Urology at the Municipal Hospital of Kassel (FRG) since 1985, 57 received a continent ileal bladder anastomosed to the membranous urethra. In a retrospective study intra- and postoperative complications, late complications and prognosis of the tumor disease of these patients were compared with those who had an ileum conduit from 1983 to 1988 (n = 44). The intra- and postoperative complications were nearly identical. During the further postoperative course, patients with a continent ileal bladder may present with strictures at the anastomosis of the ileal bladder and urethra, incomplete voiding with residual urine, secretion of water by the mucosa, and metabolic disturbances because of absorption of substances usually eliminated with the urine. The latter decreases with time as the glandular epithelium of the ileal mucosa changes into mucigenous cells with villous atrophy. The danger of local tumor recurrence and metastasis is the same in patients with an ileal bladder and an ileal conduit.     

Laparoscopic radical cystectomy with ileal conduit diversion

Remaining the gold standard treatment of muscle-invasive bladder cancer and high-risk superficial tumors, the radical cystectomy has been translated into a fully laparoscopic protocol, actually gaining more and more acceptance worldwide. In this article, a transperitoneal antegrade laparoscopic protocol is described for radical cystectomy performed in both genders. After removal of the specimen, generally through a mini-laparotomy, most of the teams perform the maneuvers for urinary diversion through an ileal conduit as an open procedure, although a completely laparoscopic procedure has been successfully achieved. Laparoscopic cystectomy will face the proof of time if oncologic rules about surgical management of transitional cell carcinoma are carefully respected to avoid any cell spillage. When obvious laparoscopic advantages for the patients are encountered with laparoscopic cystectomy, it seems unlikely that a full laparoscopic protocol, including the diversion, may gain wide acceptance; in that case, the true laparoscopic benefits would be wasted by unjustified lengthening of operative time and by compromising the quality of uretero-ileal anastomoses.     

Complications of single-stage radical cystectomy and ileal conduit

Single-stage radical cystectomy without pelvic lymphadenectomy and ileal conduit urinary diversion was performed on 241 consecutive patients over a three and one-half-year period. Operative mortality rate was 2.5 per cent; early and late complications occurred in 32 and 34 percent of patients, respectively. In general, complications were less severe than in the past. Wound complications remain a major source of morbidity, but wound disruption and anastomotic leaks have been virtually eliminated.     

全膀胱切除直肠代膀胱与回肠膀胱术疗效观察

目的:探讨膀胱全切直肠代膀胱与回肠膀胱术的效果。方法:回顾性分析全膀胱切除直肠代膀胱130例,回肠膀胱16例临床资料。结果:143例膀胱肿瘤病例,浸润性肿瘤132例。手术均顺利,术后3个月未发现上尿路梗阻积水,电解质、肾功正常范围。发生近期并发症12例,远期并发症11例。87例随访1～10年,5年生存率63%。结论:膀胱全切是浸润性膀胱癌首选治疗方法之一,直肠代膀胱和回肠膀胱都是尿流改道的较好选择,长期随访其并发症少。     

Laparoscopic radical cystectomy with ileal conduit urinary diversion

OBJECTIVE: To report on the surgical technique of laparoscopic radical cystoprostatectomy with ileal conduit urinary diversion. METHODS: A 79 years old man with histologically proven transitional cell carcinoma of the bladder stageT 2b NxMx underwent a laparoscopic radical cystoprostatectomy with ileal conduit urinary diversion. The cystoprostatectomy was performed with laparoscopic technique. Creation of the ileal conduit and the stoma were performed through a mini-laparotomy. Specific technical aspects are described. RESULTS: The procedure was completed laparoscopically. The creation of the ileal conduit and stoma were performed through a mini-laparotomy. The surgical margins were free of disease. There were no intra or postoperative complications. The operative time was 290 min. Estimated blood loss was 380 mL. Hospital stay was 6 days. At 3 months there is no evidence of disease. The patient resumed his normal activity. CONCLUSION: Laparoscopic radical cystoprostatectomy with ileal conduit urinary diversion is a feasible option for organ-confined carcinoma of the bladder. The procedure is technically demanding and should be performed in centers with large experience in laparoscopic surgery.     

完全腹腔镜根治性膀胱切除加体内改良回肠通道术的学习效果分析

目的分析术者对完全腹腔镜根治性膀胱切除(LRC)+改良回肠通道术(MIC)的学习效果。方法回顾性分析首都医科大学附属北京朝阳医院2014年4月至2019年10月42例接受完全LRC+MIC患者的临床资料。男34例,女8例;年龄(63.4±9.1)岁。其中术者1行34例手术,术者2行8例。将术者1的34例按时间顺序分为3组,第1~12例为A组,第13~23例为B组,第24~34例为C组;术者2实施的8例为D组。4组中有腹部手术史者分别为0、1、4、3例,差异有统计学意义(P<0.05);4组年龄、体质指数、美国麻醉医师协会评分等差异均无统计学意义(P>0.05)。改良术式的重要步骤包括光源透射下离断肠系膜、输出袢固定的条件下行输尿管-输出袢反流性对端吻合、缝合后腹膜缺口。比较各组患者手术时间、构建回肠通道时间、出血量、并发症发生比例、淋巴结清扫数量、切缘阳性比例等重要手术指标。结果各组手术均顺利完成,均无中转开放手术。A~C组手术时间分别为330.0(320.0,360.0)、300.0(250.0,308.0)、270.0(216.0,324.0)min,差异有统计学意义(P=0.010);3组构建回肠通道时间分别为136.5(131.3,147.5)、92.0(79.0,119.0)、79.0(72.0,115.0)min,差异有统计学意义(P<0.001)。手术时间和构建回肠通道时间组间两两比较,A、B组,A、C组差异均有统计学意义(P<0.05),B、C组差异无统计学意义(P>0.05)。3组出血量[200.0(125.0,300.0)、100.0(100.0,150.0)、200.0(100.0,400.0)ml]、并发症发生比例[4/12、4/11、3/11]、淋巴结清扫数量[(19.0±10.7)、(16.0±9.8)、(23.3±8.5)枚]、切缘阳性比例(1/12、1/11、2/11)的比较,差异均无统计学意义(P>0.05)。D组手术时间420.0(350.0,450.0)min,与A组比较差异有统计学意义(P<0.05)。D组出血量200.0(112.5,350.0)ml,并发症发生比例2/8,淋巴结清扫数量(13.8±7.1)个,切缘阳性比例1/8,与A组比较差异均无统计学意义(P>0.05)。结论完全LRC+MIC学习效果明显,随着手术例数的增加,手术时间及构建回肠通道时间显著下降;该术式具有较好的可重复性和安全性。     

Prophylactic mesh used in ileal conduit formation following radical cystectomy: a retrospective cohort

Purpose

Given the difficulty of durable repairs, there is continued interest in hernia prevention. One emerging prevention technique for parastomal hernias is prophylactic mesh placement, whereby mesh is inserted during the index procedure as hernia prophylaxis. We evaluated our experience using prophylactic mesh when creating an ileal conduit.

Methods

We retrospectively reviewed patients undergoing robotic cystectomy with ileal conduit from 6/2010 to 8/2017. Patient demographics and operative/perioperative outcomes were documented. We evaluated hernia recurrence using postoperative computed tomography scanning or physical exam. Prophylactic mesh was inserted at the operating surgeon’s discretion using a synthetic resorbable or biologic mesh.

Results

During the study period, 38 patients underwent robotic-assisted cystectomy with ileal conduit formation. Average patient age was 68 years, with 28 (74%) male and 35 (92%) Caucasian patients. Three patients (8%) required conversion to open, and one patient (3%) had a concomitant colorectal resection. Thirty-one (88%) patients had postoperative computed tomography scanning. Prophylactic mesh was used in 18 patients (47%) in a retrorectus position. Of these, 15 (83%) patients had synthetic resorbable mesh and 3 (17%) patients had biologic mesh. At average follow-up of 21 months, one hernia recurred (5%) in a patient without mesh placement at the time of ileal conduit. At an average follow-up of 11 months, there have been no recurrences and no mesh-related complications in the prophylactic mesh group.

Conclusions

Using prophylactic mesh in ileal conduit, creation is feasible and may decrease the parastomal hernia formation rate. Further study of using synthetic resorbable and biologic meshes for hernia prophylaxis is warranted.

     

Laparoscopic radical cystectomy and ileal conduit reconstruction: preliminary experience

PURPOSE: We present our preliminary experience with laparoscopic radical cystoprostatectomy for muscle-invasive carcinoma of the urinary bladder. Patient and operative data and the surgical technique are presented. PATIENTS AND METHODS: Laparoscopic radical cystoprostatectomy and bilateral pelvic lymph node dissection were performed using five or six ports by a transperitoneal approach. An ileal conduit urinary diversion was constructed at the site of specimen retrieval. RESULTS: The procedure was successful in nine of ten patients with a mean blood loss of 533 mL and an average transfusion of 1.3 units per patient. The mean operating time was 6.48 hours and an average of 33 mg of morphine equivalents was required for analgesia. The mean hospital stay was 10.8 days. One patient had surgical margins positive for cancer, while none had histologic evidence of pelvic nodal metastasis. There were five minor and major intraoperative and postoperative complications. The remaining patient, treated early in our experience, developed hypercarbia necessitating conversion to open surgery. No metastases have been seen after a mean duration of follow-up of 19 months. CONCLUSIONS: Laparoscopic radical cystoprostatectomy with open ileal conduit urinary diversion is a feasible alternative to traditional open radical cystectomy. Urinary diversion can be performed through the small incision necessary to extract the surgical (radical cystoprostatectomy) specimen from the abdomen. With our modified technique, it also is feasible to reduce the cost.     

A case of late recurrence of urothelial carcinoma in an ileal conduit after radical cystectomy and ileal conduit diversion for bladder cancer

Recurrence of urothelial cancer in an ileal conduit after radical cystectomy is rare. A 79-year-old man suffered bladder cancer (UC cTisN0M0 G2＞3) and underwent total cystectomy with ileal conduit. He had recurrence of the right renal pelvis carcinoma 6 years after the total cystectomy, and was treated by right radical nephroureterectomy (pT3 G2＝3). The patient had another episode of recurrence in the ileal conduit 13 years after the initial operation. The entire ileal conduit (UC, G3, ew (-)) was resected and left cutaneous ureterostomy was performed. This case suggests that long-term follow-up is necessary after radical cystectomy and ileal conduit for urinary diversion.     

Laparoscopic hand assisted radical cystectomy with ileal conduit urinary diversion

PURPOSE: Hand assisted laparoscopy was originally described in the early 1990s. Since then many studies have shown that hand assisted techniques have the same advantages of laparoscopy including decreased need for postoperative narcotics and rapid return to routine activities. Laparoscopic techniques are advancing rapidly and intracorporeal laparoscopic cystectomy is reported. To our knowledge we report the first case of hand assisted, laparoscopic radical cystectomy with ileal conduit urinary diversion. MATERIALS AND METHODS: A 68-year-old male with rapidly recurring grade III transitional cell carcinoma elected to undergo hand assisted radical cystectomy. We performed a radical cystectomy with bilateral pelvic lymph node dissection removing the specimen through the hand port site. The ileal loop urinary diversion was constructed by pulling the small bowel through the hand port incision. We made another separate hole for the stoma and a drain was placed through a port site. The incisions were closed in the standard fashion.RESULTS: Operative time was 7 hours with 750 cc of blood loss and no complications. All surgical margins were negative. The patient did well and was discharged from the hospital on postoperative day 7 with return to normal activity without limitations at 4 weeks. CONCLUSIONS: To our knowledge this is the first reported case of hand assisted laparoscopic radical cystectomy with ileal loop diversion. Hand assistance facilitated this technically demanding surgery resulting in a good outcome without significant added operative time.