Abstract
PurposeTo compare the peri-operative outcomes of females undergoing laparoscopic intracorporeal urinary diversions (ICUD) and extracorporeal urinary diversions (ECUD) after laparoscopic radical cystectomies (LRC).Patients and methodsThirty-eight females who underwent LRCs and urinary diversions from February 2008 to October 2018 were divided into two groups: the ECUD group (19 patients) and the ICUD group (19 patients). We retrospectively analysed the patients in terms of patients’ demographics, peri-operative outcomes, and oncological follow-ups.ResultsThere were significant differences in the mean operative times between ECUDs and ICUDs (364.6 vs. 297.1 min, p = 0.007), transfusion rates (37% vs. 5%, p = 0.042), time to flatus (5 vs. 3 days, p = 0.020), time to ambulation (2 vs. 1 days, p = 0.022), and duration of postoperative hospital stays (22 vs. 13 days, p = 0.002). The mean lymph node yield was 12.9 in the ECUD group and 18.6 in the ICUD group (p = 0.140). Seven out of 19 patients (37%) in the ECUD group and 6 out of 19 patients (32%) in the ICUD group had positive lymph nodes (p > 0.9). Two out of 19 ECUD patients (11%) and 4 of 19 ICUD patients (21%) had positive surgical margins (p = 0.660). Although there were no differences in major complications at 30 days and in all complications at 90 days, the Clavien grade II complications were significantly different at 30 days (ECUD 8, ICUD 2; p = 0.026). The mean follow-up times were 48.7 months (ECUD group) and 26.4 months (ICUD group). There were no statistically significant differences in estimated glomerular filtration rates postoperatively (p = 0.516). Seven patients had disease metastases (ECUD 2 out of 19, ICUD 5 out of 19; p = 0.405) and 5 died (ECUD 3 out of 19, ICUD 2 out of 19; p > 0.9).ConclusionsICUDs benefit females by having smaller incisions, faster recoveries, and decreased complication rates.
Highlights
Primary bladder cancer is a serious worldwide health issue [1], with the male to female morbidity being 3:1 [2]
While traditional surgeries for female patients with muscle-invasive bladder cancer (MIBC) involves anterior exenteration with dissection of the bladder, urethra, uterus, vagina, and both ovaries [5], Wu et al World Journal of Surgical Oncology (2019) 17:161 there is significant controversy regarding which diversion is more beneficial for women after laparoscopic radical cystectomies (LRC)
Indications included muscle invasive bladder cancer, T1G3 and recurrent superficial bladder cancer, or extensive non-muscle-invasive bladder cancer (NMIBC) that could not be controlled by transurethral resection bladder cancer and intravesical treatments
Summary
Primary bladder cancer is a serious worldwide health issue [1], with the male to female morbidity being 3:1 [2]. A radical cystectomy with pelvic lymph node dissection is considered the standard operative treatment for muscle-invasive bladder cancer (MIBC). Wu et al World Journal of Surgical Oncology (2019) 17:161 there is significant controversy regarding which diversion is more beneficial for women after LRC. This article aims to compare ICUDs and ECUDs following LRCs in female patients by analysing their demographics, perioperative outcomes, and oncological follow-ups
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