| Objective:Radical cystectomy(RC)and urinary diversion of bladder cancer is famous for its complicated operation,long time,excessive bleeding and complications.However,so far,it is still the gold standard for the treatment of muscle-invasive bladder cancer(MIBC)and refractory non-muscle-invasive bladder cancer(NMIBC).We modified the urinary diversion after RC,and achieved encouraging results.The purpose of this study was to evaluate the surgical effects of modified ileal conduit(IC)after RC for bladder cancer,and to analyze the oncological prognosis.Methods:A retrospective study was conducted on the database of bladder cancer patients in our hospital.A single center cohort of 211 consecutive bladder cancer patients who underwent RC + Modified IC from September 2012 to August 2019 was analyzed.Demographic data,perioperative results,early-and late complications after surgery,oncological results,and follow-up data were recorded.Kaplan-Meier method was used to plot the stage specific survival results,and the 5-year recurrence-free survival(RFS)and overall survival(OS)rate was calculated,and the statistical significance among groups was evaluated by log-rank test.Univariate and multivariate Cox regression analyses were used to assess the predictive effects of comorbidities,tumor stage,grade,and lymph node status on survival rate.Results:Of the 211 patients who received modified IC after RC,136(64.4%)underwent laparoscopic radical cystectomy(LRC)and 75(35.5%)underwent open radical cystectomy(ORC).The mean operative time(OT)was 330.07±90.65 minuts,and351.91±92.28,290.47±72.91 minuts in LRC and ORC group respectively.A total of96(45.5%)patients received a transfusion in the perioperative period,and the mean estimated blood loss(EBL)was 680.25±422.64 ml.The mean postoperative first exhaust time(PFET)and postoperative hospital stay(PHS)were 4.21±1.29 days and18.29±6.96 days.There were 87 cases of early complications and 15 cases of late complications,with a total of 102(48.3%)complications.There were 9 cases(4.3%)of complications related to uretero-ileal anastomosis,and no complications related to stoma occurred.According to Clavien-Dindo classification system,there were35,54,11,2 cases of grade I,II,III and IV complications,of which 89 cases were grade I and II,accounting for 87.3%.There were 38 cases of preoperative hydronephrosis and 22 cases of postoperative hydronephrosis,of which 22 cases decreased and 6 cases increased.There were 19,24,108,40 and 20 cases of PT0,T1,T2,T3 and T4 in postoperative pathological stages,and there were 47,147 and 17 cases of low-grade and high-grade urothelial carcinoma and non-urothelial carcinoma,respectively.None of the patients had a positive surgical margin.Of the 211 patients,the median lymphadenectomy was 14(IQR,6-18),and 18 patients had lymph node positivity.The median follow-up time was 26 months(IQR,12-43),with a total survival of 178(84.3%),a recurrence-free survival of 171(81%),and 33 deaths.14 patients had local recurrence,31 patients had distant metastasis,and 6 patients had both local recurrence and distant metastasis.The estimated 5-year OS and RFS rates were 77.20% and 79.60%.Univariate Cox regression analysis showed that preoperative comorbidities,postoperative pathological stage,grade and lymph node involvement were the significant predictors of RFS and OS.Multivariate Cox regression analysis showed that preoperative comorbidities(P=0.003),postoperative pathological stage(P=0.041),grade(P=0.017),and lymph node involvement(P=0.049)were the independent risk factors affecting OS,while preoperative comorbidities(P=0.003)and high pathological grade(P=0.042)were the independent influencing factors for RFS.Conclusions:Modified IC after RC not only can achieve lower postoperative complications,especially the lower incidence of uretero-ileal anastomosis and stoma related complications,but also can achieve the established oncological outcomes of critical radical surgery,and our outcomes is encouraging.preoperative comorbidities,postoperative pathological stage,grade,and lymph node involvement were the independent risk factors affecting OS,while preoperative comorbidities and high pathological grade were the independent influencing factors for RFS. |
