Русский
Short-term and long-term results of robot-assisted cystectomy with various types of urine derivation in patients with urothelial carcinoma of the bladder
DOI: https://dx.doi.org/10.18565/pharmateca.2023.11.52-59
A.A. Gritskevich, V.A. Okhanyan, D.M. Monakov, A.D. Simonov, A.G. Kochetov, N.A. Karelskaya, Zh. Polotbek, I.G. Rusakov
1) Vishnevsky National Medical Research Center for Surgery, Moscow, Russia; 2) Russian Biotechnological University, Moscow, Russia; 3) National Medical Research Center for High Medical Technologies – Vishnevsky Central Military Clinical Hospital, Moscow region, Krasnogorsk district, Russia; 4) Patrice Lumumba Peoples’ Friendship University of Russia, Moscow, Russia; 5) Russian Society of Urological Oncology, Moscow, Russia
Background. Cystectomy with various methods of urinary diversion remains the mainstay of treatment for patients with high-risk muscle-invasive and non-muscle-invasive bladder cancer (BC). The technical complexity and traumatic nature of this operation are the main reason for the high incidence of postoperative complications and mortality. One of the ways to reduce the morbidity of this intervention is the use of minimally invasive technologies, and robot-assisted operations are considered the most promising.
Objective. Analysis of our own experience of performing robot-assisted radical cystectomy using various methods of urine derivation.
Methods. The immediate and long-term results of treatment of 16 patients (15 men and 1 woman) with urothelial carcinoma of the bladder who underwent robot-assisted cystprostatvesiculectomy with various types of urine diversion were analyzed.
Results. The mean age of the patients was 64.6±9.0 years. The mean Charlson comorbidity index was 5±1. ECOG-0 – in 10, ECOG-1 – in 6 patients. The mean ASA score was 3. The mean body mass index was 26.0±8.1 kg/m2. Depending on the method of urine diversion, all patients were divided into 3 groups: I (n=7, 43.7%) – formation of an orthotopic urinary reservoir according to Studer, II (n=5, 31.3%) – creation of an ileoconduit according to Bricker, III (n=4, 25.0%) – bilateral ureterocutaneostomy. The average mean of the operation was 438±147 minutes (225–675 minutes), the mean blood loss was 304.2±173.8 ml (100–700 ml). Lymphadenectomy was performed in 11 patients. The average number of removed lymph nodes was 5. Metastases to the lymph nodes were detected in 3 patients (1 in each group). The number of lymph nodes affected by metastases was 1–3. Postoperative complications developed in 7 (43.8%) patients: grade II according to the Clavien-Dindo classification – in 3, grade IIIa – in 4. The mean bed-day was 24.8±6.0. Median follow-up was 20 months. Progression of the disease was observed in 2 (12.5%) patients.
Conclusion. The use of robot-assisted cystprostatvesiculectomy for surgical treatment of bladder cancer can reduce the morbidity of this surgical intervention, the frequency of early postoperative complications and achieve good oncological results.
Objective. Analysis of our own experience of performing robot-assisted radical cystectomy using various methods of urine derivation.
Methods. The immediate and long-term results of treatment of 16 patients (15 men and 1 woman) with urothelial carcinoma of the bladder who underwent robot-assisted cystprostatvesiculectomy with various types of urine diversion were analyzed.
Results. The mean age of the patients was 64.6±9.0 years. The mean Charlson comorbidity index was 5±1. ECOG-0 – in 10, ECOG-1 – in 6 patients. The mean ASA score was 3. The mean body mass index was 26.0±8.1 kg/m2. Depending on the method of urine diversion, all patients were divided into 3 groups: I (n=7, 43.7%) – formation of an orthotopic urinary reservoir according to Studer, II (n=5, 31.3%) – creation of an ileoconduit according to Bricker, III (n=4, 25.0%) – bilateral ureterocutaneostomy. The average mean of the operation was 438±147 minutes (225–675 minutes), the mean blood loss was 304.2±173.8 ml (100–700 ml). Lymphadenectomy was performed in 11 patients. The average number of removed lymph nodes was 5. Metastases to the lymph nodes were detected in 3 patients (1 in each group). The number of lymph nodes affected by metastases was 1–3. Postoperative complications developed in 7 (43.8%) patients: grade II according to the Clavien-Dindo classification – in 3, grade IIIa – in 4. The mean bed-day was 24.8±6.0. Median follow-up was 20 months. Progression of the disease was observed in 2 (12.5%) patients.
Conclusion. The use of robot-assisted cystprostatvesiculectomy for surgical treatment of bladder cancer can reduce the morbidity of this surgical intervention, the frequency of early postoperative complications and achieve good oncological results.
Keywords: ureterocutaneostomy, Bricker operation, Studer operation, extracorporeal urinary diversion, intracorporeal urinary diversion, robot-assisted cystectomy, urothelial carcinoma, cystectomy
About the Autors
Corresponding author: Aleksandr A. Gritskevich, Dr. Sci. (Med.), Head of the Department of Surgical Treatment of Urological Diseases, Professor of the Educational Department, Vishnevsky National Medical Research Center for Surgery; Professor at the Department of Urology and Operative Nephrology with a Course of Oncourology, Patrice Lumumba Peoples’ Friendship University of Russia, Moscow, Russia; grekaa@mail.ru
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