Page 4 - World Journal of Laparoscopic Surgery

Reva Sergey et al
MATERIALS AND METHODS protocol, the operation time, bleeding volume, and blood
transfusion rates were checked and analyzed. In the
Between January 2012 and March 2014, 42 convective
patients underwent RC at our institution as initial early postoperative period, we assessed the impact of the
treatment for muscle invasive or locally advanced BCa, surgery type on duration of hospitalization (totally and
with no evidence of distant metastasis. Among these in ICU), intestinal and urinary complications separately
patients, 21 underwent LRC (group 1) and 21 ORC (group 2). in the 30- and 90-day periods, readmission and reop-
The study protocol was approved by the institutional eration rates. All patients were eligible for a minimum
review board of N.N. Petrov Research Institute of 90-day follow-up. The follow-up data were collected from
Oncology. Pretreatment characteristics of patients a patient survey 1 month after cystectomy and once per
are presented in Table 1. Preoperative evaluation was 3 months thereafter. Patients with positive surgical mar-
conducted according to the current European Association gins were managed in an adjuvant setting.
of Urology (EAU) guidelines. Patients with previous Differences in proportions and means were tested
radiation therapy and/or radiotherapy were excluded using a two-sided t-test. The value of p ≤ 0.05 was accepted
from the study. Among all patients, in 2 (3.9%) of them as statistically significant in rejecting the null hypothesis
cystectomy was performed due to non-muscle invasive (no difference in proportions/means).
bladder cancer (NMIBC), refractory to the intravesical RESULTS
BCG therapy. Preparation to the cystectomy included inter
alia, mechanical (enema), or medicamental (laxatives) Intraoperative and Pathomorphological Data
intestinal preparation. Open radical cystectomy and The operative data are summarized in Table 2. The
LRC were performed by one or two surgeons (AN or average operating time was higher in the LRC group
SP). The indications, contraindications, and techniques when assessed totally (368 vs 263 minutes) and separately
were described previously. 9-11 Briefly, according to in the extirpative (143 vs 118 minutes) and reconstructive
the treatment protocol, standard or extended pelvic (225 vs 145 minutes) steps, in laparoscopic and open
lymphadenectomy was performed in all cases; during surgery respectively (p = 0.04). Among intraoperative
the procedure in male patients, prostate and seminal complications, the most serious one was damaging of
vesicles were removed, whereas in women patients the the major blood vessels – one case in each group (due to
ovarian, uterus, and anterior vagina wall were removed. intracorporeal sutures). The most frequent complication
In all the cases, purely intracorporeal incontinent urinary was bleeding (grade 2) which required blood transfusion
diversion was performed. seven times higher (33.3 vs 4.7%) in the ORC group
The postoperative care included no use of the (p = 0.02). No intraoperative mortality was observed.
nasogastric tube, early activation (1 day postoperatively), None of the cases required conversion to open cystectomy.
and early feeding (2 to 3 days postoperatively) of the The median hospitalization duration was 12.6 and
patient. Removal of the abdominal drain was made when 21.1 days, which largely depended on (1) Perioperative
the output was < 100 mL/day. The ureteral stents were comorbidity and (2) the day of removal of urethral stents.
removed 10 to 14 days postoperatively. The main intestinal function recovery criteria –
Intraoperative, postoperative 30- and 90-day com- median time to regular diet and to stool – were 4.3 and
plications were assessed according to the modified 4.4 days in the LRC group, and 6.2 and 7.5 days in the
12
Clavien–Dindo classification. Pursuant to the patient
ORC group (p-value < 0.05 between the groups in both
Table 1: Pretreatment patient characteristics cases).
Value
Variable LRC (n = 21) ORC (n = 21) Table 2: Operative data
Age (y) (average, IQR) 64.0 (37–78) 68.4 (52–80) Median value
Clinical tumor stage, n (%) Variable LRC (n = 21) ORC (n = 21)
сТ1 1 (4.3) 2 (9.5) Total operative time, min 368 263
сТ2 6 (26.1) 1 (4.8) Extirpative component time, min 143 118
сТ3-4 6 (26.1) 7 (33.3) Reconstructive component time, min 225 145
Sex: Estimated blood loss, mL 285 577
Male, n (%) 19 (90.4) 21 (100) Transfusion rate, % 4.7 33.3
Female, n (%) 2 (9.6) – Time to regular diet, days 4.3 6.2
BMI, kg/m 2 34 32 Length of ICU stay, days 2.0 3.1
Previous surgery, n (%) 7 (33.3) 5 (23.8) Time of hospital stay, days 12.6 21.1
LRC: Laparoscopic radical cystectomy; ORC: Open radical LRC: Laparoscopic radical cystectomy; ORC: Open radical
cystectomy; IQR: Interquartile range cystectomy; ICU: Intensive care unit
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