Analysis The Clinical Therapeutic Effect Of Laparoscopic Radical Cystectomy

Objective：To evaluate clinical efficacy of laparoscopic radical cystectomy for bladdercancer．Methods：We retrospectively reviewed all data of95consecutive patients who underwentlaparosocopic radical cystectomy from July2007to December2012for bladdercancer at our institution.The cases include90males and5females,The clinic datawere recorded,information including complications、urinary continence、survival andrecurrence data of discharged patients were collected by telephone follow-up，alldates statistically analyzed by SPASS。Results:Of a total of95patients who underwent LRC and urinary diversion,31patientswere treated with cutaneous ureterostomy,orthotopic ileal neobladder was performedin64cases。All the patients underwent the operation successfully besides1case ofintraoperative conversion to open surgery,media survival time were466±126minites，the mean number of lymph node harvested was14.97(range:4～39), while thenumber was14.7(range:5-37) in standard PLND and19.61(range:8-39) for theextended PLND。There was involvement of the lymph nodes in25patients (26.3%).Non-organ confined tumor in33patients (pT3～T4a;34.7%),Surgical margins rateswas3%。All complications were reported according to the Martin criteria and weregraded according to the Clavien system,51.5%(49/95) of patients experienced acomplication within90d of surgery. Among patients who experiencing acomplication,77%had only‘‘minor’’(grade1–2) complications,Major (grade3–5)complications occurred in only12%of the cohort(12/95). The30-d mortality rate was1.0%,Perioperative blood product transfusions were given in25%of patients(24/95)。The most common complications in order were intestinal obstruction,pulmonary and urinary tract infection, lymphatic fistulas。The median follow-up was 21.5months(6～58months),in the orthotopic ileal neobladder cohort,Completecontinence was achieved in24patients（24/52，46.1%）,Daytime Continence rates is84.61%(46/52), nighttime Continence rates is46.1%（24/52）。Overall,11patiens(11.5%) with local recurrence alone and13patients (13.6%) with distantmetastasis,There was1patients (1%) with both recurrence and distant metastasis。20patients (21%）died:18patients (19%) from tumor metastasis or recurrence and2patients (2%) from tumor-unrelated causes。 The estimated36monthsoverall,recurrence-free survival rates were58.0％、76.0％respectively;The estimated36months actuarial OS rates were75.0％for organ-confined disease, and20.0％fornon-organ-confined disease, The RFS rates were78.0％,76.0％respectively。Theestimated36months actuarial OS rates were69.0％for node-negative disease, and28.0％for node positive disease, The RFS rates were86.0％,48.0％respectively。Conclusion:LRC is an effective surgery for treatmenting of bladder cancer，and further studyis needed for the long-term follow-up results。...