OBJECTIVE: To describe a technique for radical cystectomy with extraperitonealization of orthotopic neobladder (RCEN) that reduces bowel-related complications by preservation of the peritoneum.
| Peritoneal preservation and extraperitonealization of the neobladder or ileal conduit would be the ideal anatomic configuration after anterior exenteration. This anatomic restoration makes patients' digestive function comfortable. However, during radical cystectomy, this whole-peritoneum preservation technique should be applied only to early stage bladder cancer, not to advanced cases, because cancer biolation could have occured even though a radical procedure like lymphadenectomy is possible. Dong Soo Park, MD, PhD, Professor of Urology and Prostate Center, Bundang CHA General Hospital, CHA University, Sungnam, South Korea |
MATERIALS AND METHODS: Fifteen patients with non-metastatic bladder cancer underwent RCEN by a peritoneum preserving technique. The study included 13 patients with T1 high-grade bladder cancer and 2 with T2a bladder cancer. To compare perioperative outcomes including bowel-related complications, we also reviewed 15 patients who underwent traditional cystectomy with ileal Studer neobladder who were matched for age, sex, body mass index, American Society of Anesthesiologists (ASA) score, tumor stage, tumor grade, tumor size, and location. Female genital organs were preserved in five female patients who underwent the RCEN technique.
RESULTS: There was no significant difference between the two cohorts (RECN vs. traditional technique) with respect to age, body mass index, ASA score, or tumor characteristics. The mean operative time was similar between the two groups. The patients who underwent RECN exhibited earlier recovery of normal gas pattern on plain abdominal X-ray during the postoperative period and an earlier resumption of normal diet. The mean hospital stay was shorter in the RECN group than the traditional group.
CONCLUSIONS: The RECN technique preserving the whole peritoneum is a feasible approach that significantly reduces bowel-related complications in selected patients.
Written by:
Park DS, Gong IH, Choi DK, Hwang JH, Kang MH, Oh JJ. Are you the author?
Department of Urology, CHA Bundang Medical Center, CHA University, 351 Yatap-dong, Bundang-gu, Songnam, 463-712, Korea.
Reference: Int Urol Nephrol. 2013 Dec 20. Epub ahead of print.
doi: 10.1007/s11255-013-0632-7
PubMed Abstract
PMID: 24356919
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