Comparison of the anti-reflux ileum valve-pouch orthotopic neobladder and the Studer technique after radical cystecomy: surgical and renal functional outcomes.
Zaisheng Zhu, Yiyi Zhu, Wenmin Ying, Han Wu, Penfei Zhou, Quanqi Liu, Jianyong Tong, Yueping Wang
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引用次数: 0
Abstract
Background: This study describes the construction of an anti-reflux neobladder using an ileum valve-pouch (IVP) and compares its efficacy with that of the modified Studer-pouch (MSP).
Methods: This study included a total of 127 patients who underwent radical cystectomy + neobladder construction (IVP: n = 66; MSP = 61) between January 2015 and June 2023 at two major medical centers in our city. Potential bias was reduced by 1:1 propensity score matching (PSM) to compare oncology, complications, and renal function protection between the two groups. The estimated glomerular filtration rate (eGFR) was calculated using the CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) equation. Survival was assessed using Kaplan-Meier analysis.
Results: The median follow-up time was 44.5 and 35.5 months in the IVP and MSP groups, respectively. After propensity scoring, 84 patients (42 in each group) were included in the analysis.There was no significant statistical difference in the operation time(p = 0.128) and the time of urinary diversion (p = 0.354) between the two groups.Kaplan-Meier curves showed no significant differences in cancer-specific survival (CSS) (p = 0.181) and overall survival (OS) (p = 0.611) between the two groups. In addition, the total complications and renal function were not statistically different between the two groups (p > 0.05). The incidence of patients who needed to be re-hospitalized due to urinary tract infection was lower in the VIP group than in the MSP group (p = 0.039). At 12 months postoperatively, lower rates of decreased eGFR and renal function damage were observed in the IVP group compared to the MSP group (p = 0.031 and < 0.001), which were significantly related to the type of neobladder (p = 0.004) and preoperative eGFR values (p < 0.001).
Conclusion: The preliminary results of VIP technique are safe and effective. It does not increase the time of anti-reflux construction. The incidence of complications similar in the two groups. However, the protection of renal function at 12 months after surgery seemed to be superior to MSP.The independent factors affecting renal function damage are neobladder type and preoperative eGFR.
期刊介绍：
World Journal of Surgical Oncology publishes articles related to surgical oncology and its allied subjects, such as epidemiology, cancer research, biomarkers, prevention, pathology, radiology, cancer treatment, clinical trials, multimodality treatment and molecular biology. Emphasis is placed on original research articles. The journal also publishes significant clinical case reports, as well as balanced and timely reviews on selected topics.
Oncology is a multidisciplinary super-speciality of which surgical oncology forms an integral component, especially with solid tumors. Surgical oncologists around the world are involved in research extending from detecting the mechanisms underlying the causation of cancer, to its treatment and prevention. The role of a surgical oncologist extends across the whole continuum of care. With continued developments in diagnosis and treatment, the role of a surgical oncologist is ever-changing. Hence, World Journal of Surgical Oncology aims to keep readers abreast with latest developments that will ultimately influence the work of surgical oncologists.
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