TOTALLY INTRACORPOREAL LAPAROSCOPIC RADICAL CYSTECTOMY WITH ORTHOTOPIC “U” SHAPED ILEAL NEOBLADDER

Abstract

Radical cystectomy with pelvic lymph node dissection is the standard treatment for muscle-invasive and high-risk non-muscle-invasive bladder cancer (BCa). Aim of this study is to describe and to report our case series of first 30 patients submitted to laparoscopic radical cystectomy with intracorporeal orthotopic ileal "U" shaped neobladder configuration.
No case required conversion to open surgery and there were no perioperative mortalities. The median operative time was 295 min. The median blood loss was 247 ml, with a transfusion rate of 17%. The mean number of lymph nodes removed was 14 (range:7–29). The mean hospitalization time was 10.1 days. Intra-abdominal drain was removed in all patients on postoperative day 3, bilateral ureteral stent removal on day 14, and bladder catheter removal on postoperative day 15 or later, depending on postoperative cystography control. At 6 months follow-up, the daytime and nighttime continence rates were 80% (24 of 30) and 60 % (18 of 30), respectively.Regarding pathological outcomes no patient had a positive soft tissue margin on final pathology. In the entire cohort 73% of patients had pathologically organ confined disease (pT2 or less) with 13% having local extravesical disease (pathological stage T3 or T4) and 13% with node positive disease (pTxN+).