939 DIVERSION RELATED COMPLICATIONS AFTER LAPAROSCOPIC AND OPEN RADICAL CYSTECTOMY

Abstract

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion II1 Apr 2010939 DIVERSION RELATED COMPLICATIONS AFTER LAPAROSCOPIC AND OPEN RADICAL CYSTECTOMY Ricardo Brandina, Andre Berger, Alvaro Bosco, Monish Aron, Mihir Desai, Inderbir S. Gill, and Steven Campbell Ricardo BrandinaRicardo Brandina Los Angeles, CA More articles by this author , Andre BergerAndre Berger Los Angeles, CA More articles by this author , Alvaro BoscoAlvaro Bosco Cleveland, OH More articles by this author , Monish AronMonish Aron Los Angeles, CA More articles by this author , Mihir DesaiMihir Desai Los Angeles, CA More articles by this author , Inderbir S. GillInderbir S. Gill Los Angeles, CA More articles by this author , and Steven CampbellSteven Campbell Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1818AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Open radical cystectomy (ORC) is the gold standard treatment for muscle-invasive bladder cancer. Laparoscopic radical cystectomy (LRC) with extracorporeal reconstruction is a minimally invasive alternative for the management of this disease. However, relatively short ureteral length and body habitus may make the diversion more challenging and could theoretically predispose to ureteral strictures and other diversion related complications. Herein we compare diversion related complications in patients who underwent ORC and LRC. METHODS A retrospective review was undertaken of 151 patients managed with either LRC (extracorporeal diversion) or ORC performed between August 2005 and November 2008. Diversion related and other clinical parameters were obtained from patient charts and review of the Social Security Death Index. RESULTS There were no significant differences between the LRC (n=64) and ORC (n=87) group with respect to mean patient age (70 vs. 69; p =0.7), BMI (28 vs. 28; p= 0.9), sex, ASA class, and operative indications. The ORC group had a higher prevalence of CKD and smoking history. The distribution of urinary diversions was similar between LCR (46 ileal conduit, 12 orthothopic neobladder, 6 continent cutaneous) and ORC groups (66 ileal conduit, 13 orthotopic neobladder, 8 continent cutaneous). The pathological findings were organ confined tumor (≤pT2 or less) or non-organ confined tumor (pT3-4) in 67% and 33% of the LCR cases and 58% and 42% of the ORC cases, respectively (p=0.25). The number of nodes retrieved was higher in ORC group (24 vs. 17, p=0.03). There were no differences between overall intraoperative complications (3% vs. 3%) and postoperative minor (21% vs. 31%, p=0.21) and major complications (8% vs. 7%, p=0.8). Seventeen diversion related complications were identified including: LRC (n = 9, 14%) with 7 ureteral stenosis, 1 total incontinence after neobladder requiring AUS, 1 urinary fistula requiring percutaneous bilateral nephrostomy tubes; ORC (n =8, 9.1%) with 6 ureteral stenosis, 1 neobladder disruption and 1 enteroureteral fistula. CONCLUSIONS Diversion related complications were marginally increased with LRC compared to ORC, although these evaluations did not reach statistical significance. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e366 Peer Review Report Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ricardo Brandina Los Angeles, CA More articles by this author Andre Berger Los Angeles, CA More articles by this author Alvaro Bosco Cleveland, OH More articles by this author Monish Aron Los Angeles, CA More articles by this author Mihir Desai Los Angeles, CA More articles by this author Inderbir S. Gill Los Angeles, CA More articles by this author Steven Campbell Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...