Laparoscopic Radical Cystectomy Combined With Neoadjuvant Chemotherapy In Muscle-Infiltrating Invasive Bladder Cancer

Objective: To explore the efficacy of neoadjuvant chemotherapy combined with laparoscopic radical resection for bladder cancer in the treatment of myometrial invasive bladder cancer.To summarize the advantages and experience of laparoscopic radical resection of bladder cancer combined with neoadjuvant chemotherapy,and further understand the clinical efficacy of neoadjuvant chemotherapy and postoperative patients.Methods: From 2017 to 2023,43 patients with myometrial invasive bladder cancer and T3NXM0 stage were collected from the Department of Urology of Jining First People’s Hospital.The operation method was laparoscopic radical cystectomy.According to whether neoadjuvant chemotherapy is performed before surgery,it is divided into two groups:the neoadjuvant chemotherapy combined with laparoscopic radical cystectomy group and the simple surgery group.Evaluate the changes in bladder tumor diameter after 2 cycles of neoadjuvant chemotherapy in patients undergoing neoadjuvant chemotherapy,as well as the changes in bladder tumor diameter before neoadjuvant chemotherapy,and the adverse reactions of patients after neoadjuvant chemotherapy.We evaluate the efficacy of patients after neoadjuvant chemotherapy based on the tumor efficacy evaluation standard RECIST1.1,and grade the adverse reactions of patients after neoadjuvant chemotherapy according to the evaluation standard of adverse event CTCAE5.0 grading standard.The clinical data of the two groups of patients were analyzed using propensity score matching(PSM),Chi-square test,multiple regression analysis,etc.to evaluate whether there were statistical differences in surgical time,bleeding volume,blood transfusion volume,and hospitalization days after neoadjuvant chemotherapy.Through the above evaluation,we summarized the experience of laparoscopic radical surgery for bladder cancer and the advantages of patients after preoperative neoadjuvant chemotherapy.Results:1.Among the 43 patients,15 received neoadjuvant chemotherapy with GP regimen(gemcitabine,cisplatin),and 14 successfully completed the surgery.One patient is currently undergoing neoadjuvant chemotherapy.Among the 15 people,4 had complete remission of bladder tumors,3 had no significant changes in tumor size compared to before,7 had partial remission of tumors,and 1 had slight tumor development compared to before.Of the 15 patients with neoadjuvant chemotherapy,2 had no obvious adverse reactions,and the other 13 had adverse reactions related to digestive system and blood system.According to the classification criteria of adverse reactions and adverse events CTCAE5.0,no adverse reactions were about 15.40%,grade I adverse reactions were about 60%,grade II adverse reactions were33.33%,grade III adverse reactions were about 6%,and there were no deaths.Adverse reactions caused by neoadjuvant chemotherapy are mainly manifested in nausea and diarrhea in the digestive system,and bone marrow suppression in the blood system.The above adverse reactions are gradually improved through clinical observation or medical adjuvant treatment,and no serious life-threatening phenomenon and death cases are found.2.Among the 15 patients undergoing neoadjuvant chemotherapy,2did not show any significant adverse reactions,while the remaining 13 experienced adverse reactions related to the digestive system,blood system,etc.Corresponding to the CTCAE5.0 classification criteria for adverse reactions and adverse events,there were approximately 15.40%of no adverse reactions,60% of grade I adverse reactions,33.33% of grade II adverse reactions,and 6% of grade III adverse reactions.There were no deaths.The adverse reactions caused by neoadjuvant chemotherapy are mainly reflected in nausea and diarrhea in the digestive system,and bone marrow suppression in the hematological system.These adverse reactions have gradually improved through clinical observation or internal adjuvant treatment,and no serious life-threatening phenomena or deaths have been found.3.In terms of perioperative conditions,there was no statistically significant difference between the neoadjuvant chemotherapy combined with laparoscopic radical cystectomy group and the simple laparoscopic radical cystectomy group in terms of average surgical duration,average postoperative retention time of gastric tubes,and average postoperative removal time of abdominal and pelvic drainage tubes.The neoadjuvant chemotherapy combined with surgery group had more average intraoperative blood loss,earlier average start of ambulation after surgery,and earlier average removal time of pelvic drainage tubes after surgery,Postoperative intestinal ventilation requires longer time.In terms of postoperative complications,the total incidence of neoadjuvant chemotherapy combined with laparoscopic radical cystectomy was higher,the number of re indwelling gastric tube was less,and the proportion of urinary tract infection was higher,but the incidence rate of intestinal complications was the same in the two groups.There was no statistically significant difference in preoperative and postoperative albumin values between the two groups,as well as intraoperative bleeding.However,the neoadjuvant chemotherapy combined with laparoscopic radical cystectomy group had a lower difference in preoperative and postoperative albumin values,resulting in less intraoperative bleeding.Compared with the control group,the neoadjuvant chemotherapy combined with laparoscopic radical cystectomy group had shorter hospital stay,but the difference was not statistically significant(P>0.05).4.One patient developed multiple pelvic metastases and intestinal obstruction 4 months after surgery.Conclusion: Laparoscopic radical resection of bladder cancer combined with neoadjuvant chemotherapy is a safe and effective way to treat myometrial invasive bladder cancer,which is conducive to expanding the surgical indications,reducing the tumor recurrence rate,and has a promotional significance for the treatment of advanced bladder cancer.