Technology and experience in laparoscopic radical cystectomy with ileal conduit

Abstract

Objective To investigate the safety and efficacy of laparoscopic radical cystectomy with ileal conduit.Methods Fifty-four cases of laparoscopic radical cystectomy with ileal conduit (22 cases in T2 stage,27 cases in T3 stage,and 5 cases in T4a stage) were performed from May 2008 to June 2011.Forty-nine cases were males and 5 cases were females.The perioperative conditions,postoperative complications,and treatment methods were analyzed respectively and follow-up was carried out.Results The median operative time was 340 min (240-420 min),the mean intraoperative blood loss was 220 ml (100-400 ml),postoperative intestinal function recovery time was 3-6 days,and no perioperative death occurred.The total postoperative complication rate was 20.4％ (11/54).Three cases had positive margins in pathology,and local radiotherapy was perfomed postoperatively.The average number of lymph nodes in laparoscopic pelvic lymphadenectomy was 10 per person.Four cases were positive with lymph node,and all node-positive patients received adjuvant systemic chemotherapy after postoperative recovery.The overall survival rate was 79.6％ (43/54) with an average follow-up of 2.9 years (1.5-4.5 years).Conclusions For patients without surgery opportunities of orthotopic ileal neobladder,laparoscopic radical cystectomy with ileal conduit could be a safe and feasible minimally invasive option,with less bleeding and fewer complications.The postoperative early tumor radical effect is good,and for the patients with local positive margins could receive local salvage pelvic radiotherapy. Key words: Laparoscopes; Cystectomy; Urinary diversion; Ileal conduit; Urinary bladder neoplasms