Background:Radical cystectomy and urinary diversion remains the standard surgical treatment for patients with muscle-invasive or high-risk or recurrent non-muscle-invasive bladder cancer.Although this approach prolong...Background:Radical cystectomy and urinary diversion remains the standard surgical treatment for patients with muscle-invasive or high-risk or recurrent non-muscle-invasive bladder cancer.Although this approach prolongs patient survival remarkably,there are postoperative complications associated with urinary diversion.This study aimed to assess the efficacy of modified ileal conduit surgery for reducing early and late stoma-and ureteroileal anastomo-sis-related complications,as compared with conventional ileal conduit urinary diversion.Methods:We retrospectively evaluated the clinical data of bladder cancer patients treated with radical cystectomy and ileal conduit urinary diversion at Sun Yat-sen University Cancer Center between January 1,2000 and June 30,2016.Ileal conduit was created by the conventional or a modified technique.The clinicopathologic features of the conventional and the modified ileal conduit groups were compared using the t test and the Chi square test.Multivari-able logistic regression analysis and multivariable Cox regression analysis were performed to determine the odds of developing stoma-and ureteroileal anastomosis-related complications in the two groups.Results:145 and 100 patients underwent the modified and conventional ileal conduit surgery,respectively.The two groups were comparable with regard to clinicopathologic features.The rate of stoma-related complications was significantly lower in the modified ileal conduit group than in the conventional ileal conduit group(0.7%vs.17.0%,P<0.001).No late stoma-related complications were seen in the modified ileal conduit group,but were seen in 13(13.0%)patients in the conventional ileal conduit group.The rate of ureteroileal anastomosis-related complications was significantly lower in the modified ileal conduit group than in the conventional ileal conduit group(4.8%vs.15.0%,P=0.001).In multivariable analyses,the modified ileal conduit group was significantly less likely to develop stoma-(odds ratio[OR]=0.024,95%confidence interval[CI]0.003-0.235;P=0.001)or ureteroileal anastomosis-related complications(OR=0.141,95%CI 0.042-0.476;P=0.002)than the conventional ileal conduit group.Conclusions:Our modified surgical technique for ileal conduit urinary diversion may be effective for reducing early and late complications related to the stoma and the ureteroileal anastomosis.Prospective randomized clinical trials are needed to confirm our results.展开更多
Objectives:To investigate the role of complete transurethral resection of bladder tumor(TURBT)before radical cystectomy(RC)for organ-confined bladder cancer.Materials and methods:Data of patients who underwent RC in o...Objectives:To investigate the role of complete transurethral resection of bladder tumor(TURBT)before radical cystectomy(RC)for organ-confined bladder cancer.Materials and methods:Data of patients who underwent RC in our center from January 2008 to December 2018 were retrospectively reviewed.Patients with>T2N0M0 disease and positive surgical margins and those who received neoadjuvant/adjuvant chemotherapy or radiotherapy were excluded.Complete TURBT was defined as no visible lesion under endoscopic examination after TURBT or in the bladder specimen after RC.Kaplan-Meier curves and log-rank tests assessed disease-free survival(DFS).Logistic and Cox regression analyses were performed to identify potential predictors.Results:A total of 236 patients were included in this review,including 207 males,with a median age of 61 years.The median tumor size was 3 cm,and a total of 94 patients had identified pathological T2 stage disease.Complete TURBT was correlated with tumor size(p=0.041),histological variants(p=0.026),and down-staging(p<0.001).Tumor size,grade,and histological variants were independent predictors of complete TURBT.During a median follow-up of 42.7 months,30 patients developed disease recurrence.Age and histological variants were independent predictors of DFS(p=0.022 and 0.032,respectively),whereas complete TURBT was not an independent predictor of DFS(p=0.156).Down-staging was not associated with survival outcome.Conclusions:Complete TURBT was correlated with an increased rate of down-staging before RC.It was not associated with better oncologic outcomes for patients with organ-confined bladder cancer.展开更多
文摘Background:Radical cystectomy and urinary diversion remains the standard surgical treatment for patients with muscle-invasive or high-risk or recurrent non-muscle-invasive bladder cancer.Although this approach prolongs patient survival remarkably,there are postoperative complications associated with urinary diversion.This study aimed to assess the efficacy of modified ileal conduit surgery for reducing early and late stoma-and ureteroileal anastomo-sis-related complications,as compared with conventional ileal conduit urinary diversion.Methods:We retrospectively evaluated the clinical data of bladder cancer patients treated with radical cystectomy and ileal conduit urinary diversion at Sun Yat-sen University Cancer Center between January 1,2000 and June 30,2016.Ileal conduit was created by the conventional or a modified technique.The clinicopathologic features of the conventional and the modified ileal conduit groups were compared using the t test and the Chi square test.Multivari-able logistic regression analysis and multivariable Cox regression analysis were performed to determine the odds of developing stoma-and ureteroileal anastomosis-related complications in the two groups.Results:145 and 100 patients underwent the modified and conventional ileal conduit surgery,respectively.The two groups were comparable with regard to clinicopathologic features.The rate of stoma-related complications was significantly lower in the modified ileal conduit group than in the conventional ileal conduit group(0.7%vs.17.0%,P<0.001).No late stoma-related complications were seen in the modified ileal conduit group,but were seen in 13(13.0%)patients in the conventional ileal conduit group.The rate of ureteroileal anastomosis-related complications was significantly lower in the modified ileal conduit group than in the conventional ileal conduit group(4.8%vs.15.0%,P=0.001).In multivariable analyses,the modified ileal conduit group was significantly less likely to develop stoma-(odds ratio[OR]=0.024,95%confidence interval[CI]0.003-0.235;P=0.001)or ureteroileal anastomosis-related complications(OR=0.141,95%CI 0.042-0.476;P=0.002)than the conventional ileal conduit group.Conclusions:Our modified surgical technique for ileal conduit urinary diversion may be effective for reducing early and late complications related to the stoma and the ureteroileal anastomosis.Prospective randomized clinical trials are needed to confirm our results.
基金supported by the Fundamental Research Fund for Central Universities(grant 20ykpy179)Medical Science Fund of Guangdong Province(A2020139).
文摘Objectives:To investigate the role of complete transurethral resection of bladder tumor(TURBT)before radical cystectomy(RC)for organ-confined bladder cancer.Materials and methods:Data of patients who underwent RC in our center from January 2008 to December 2018 were retrospectively reviewed.Patients with>T2N0M0 disease and positive surgical margins and those who received neoadjuvant/adjuvant chemotherapy or radiotherapy were excluded.Complete TURBT was defined as no visible lesion under endoscopic examination after TURBT or in the bladder specimen after RC.Kaplan-Meier curves and log-rank tests assessed disease-free survival(DFS).Logistic and Cox regression analyses were performed to identify potential predictors.Results:A total of 236 patients were included in this review,including 207 males,with a median age of 61 years.The median tumor size was 3 cm,and a total of 94 patients had identified pathological T2 stage disease.Complete TURBT was correlated with tumor size(p=0.041),histological variants(p=0.026),and down-staging(p<0.001).Tumor size,grade,and histological variants were independent predictors of complete TURBT.During a median follow-up of 42.7 months,30 patients developed disease recurrence.Age and histological variants were independent predictors of DFS(p=0.022 and 0.032,respectively),whereas complete TURBT was not an independent predictor of DFS(p=0.156).Down-staging was not associated with survival outcome.Conclusions:Complete TURBT was correlated with an increased rate of down-staging before RC.It was not associated with better oncologic outcomes for patients with organ-confined bladder cancer.
