CU 13. Pilot study of laparoscopic radical cystectomy and construction of orthotopic T pouch ileal neobladder

Objective: To introduce the initial experience of 13 cases of laparoscopic radical cystectomy and construction of orthotopic T pouch ileal neobladder, and evaluation of oncological and functional results of this procedure.

Methods: From August 2005 through July 2009, 13 patients underwent radical cystectomy and standard lymphadenectomy followed by construction of orthotopic T pouch ileal neobladder by 5 cm mini-laparostomy for muscle invasive bladder cancer. Data were analyzed according to procedure time, blood loss, transfusion, number of dissected lymph nodes, peri-operative complications, morphology and function of upper urinary tract, and status of urinary continence.

Results: Mean operating time was 6.3 (5-8) hrs, estimated blood loss 480 (100-800) mL, transfusion 133 (0-400) mL, lymph nodes dissected 16 (8-22), no peri-operative death, perioperative complications was found in 15.4% (2/13) including 1 urine leak at neobladder-urethra junction which was managed by drainage and 1 urine leak at ureter-neobladder junction which was repaired. Complete daytime continence rate was 84.6% (11/13); complete night-time continence rate 46.1% (6/13) and 1 pad in 30.8% (4/13). No reflux into afferent limb of neobladder was observed by cystography. Temporary dilation of upper urinary tract was observed in 23.1% (3/13) in 45 days post-operative, then disappeared spontaneously, Serum creatinine remained in normal range in all patients. With 24 (16-63) months follow-up, 7.7% (1/13) died of myocardial infarction 55 months after surgery, 92.3% (12/13) survived without local relapse or distal metastasis.

Conclusions: With intermediate follow-up, the oncological and functional results are encouraging after laparoscopic radical cystectomy and construction of orthotopic T pouch ileal neobladder by mini-laparostomy; The anti-reflux mechanism is effective to protect the morphology and function of upper urinary tract.