Feasibility and safety of retrograde radical cystectomy under combined spinal and epidural anesthesia in high-risk and elderly patients. A single surgeon experience

IF 0.8 Q4 UROLOGY & NEPHROLOGY
A. Khawaja, Y. Dar, M. Suhail, K. Sofi, Prince Muzaffar, Sajad A Parra, S. Malik, A. Bhat, M. Wani
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Abstract

Purpose: The purpose of the study is to study feasibility and safety of retrograde radical cystectomy (RC) under regional anesthesia (RA) in high-risk and elderly patients of muscle invasive bladder carcinoma. Materials and Methods: This study was an observational study, conducted in the department of urology, SKIMS, Kashmir, India, from 2012 to 2020. All patients underwent retrograde RC under RA. Results: Thirty-seven patients were operated with median follow-up period of 32 months and included 30 male and 7 female patients with median age of 74.5 years (70–83 years). The American Society of Anesthesiologists score was II in 20 patients, III in 15 patients, and IV in 2 patients. All the patients included in study had significant comorbidities. All patients were anemic and required preoperative blood transfusions for optimization. Total blood loss ranged from 200 to 900 ml (mean: 400 ml). Bilateral internal iliac artery was ligated preemptively in all patients. Total transfusion required ranged from one to six units (mean: 2 units). Number of lymph nodes removed ranged from 15 to 35 (mean: 20). Total peritoneal exposure time ranged from 0 to 70 min (mean: 50 min). None of the patient needed intensive care postoperatively. Gastrointestinal tract (GIT) recovery time ranged from 1 to 4 days (mean of 1.5 days). Total hospital stay ranged from 7 to 15 days (mean: 9 days). On follow-up, one patient had stent (feeding tube) fracture, and the residual fragment was managed by antegrade approach. One patient had ureteroileal anastomotic stricture which was managed by refashioning of the anastomosis (Bricker to Wallace). One patient had stomal stenosis with features of recurrent urinary tract infections and underwent refashioning of stoma with stabilization of renal function. Conclusion: To circumvent the need of postoperative ventilation, intensive care unit admission, and prolonged hospital stay, we advocate retrograde extraperitoneal RC under combined RA (CRA) as preferred approach of surgical intervention in high-risk and elderly patients with little abdominal organ disturbance and early bowel recovery.
脊髓硬膜外联合麻醉下逆行膀胱根治术治疗高危老年患者的可行性及安全性。一个外科医生的经历
目的:研究区域麻醉(RA)下逆行膀胱根治术(RC)治疗高龄及高危肌肉浸润性膀胱癌的可行性和安全性。材料与方法:本研究是一项观察性研究,于2012年至2020年在印度克什米尔SKIMS泌尿科进行。所有患者在RA下行逆行RC。结果:手术37例,中位随访期32个月,其中男30例,女7例,中位年龄74.5岁(70 ~ 83岁)。美国麻醉医师学会评分:20例为II, 15例为III, 2例为IV。所有纳入研究的患者均有显著的合并症。所有患者均为贫血,术前需输血优化。总失血量为200 ~ 900毫升(平均400毫升)。所有患者均预先结扎双侧髂内动脉。总输血需求从1到6个单位不等(平均:2个单位)。淋巴结切除数15 ~ 35个(平均20个)。总腹膜暴露时间为0 ~ 70分钟(平均50分钟)。所有患者均无需术后重症监护。胃肠道(GIT)恢复时间1 ~ 4天,平均1.5天。总住院时间为7至15天(平均9天)。随访中,1例患者发生支架(饲管)骨折,剩余碎片行顺行入路处理。1例输尿管输尿管吻合口狭窄,行吻合口重塑术(Bricker to Wallace)。1例患者因造口狭窄伴反复尿路感染,行造口重塑术,肾功能稳定。结论:为避免术后需要通气、入住重症监护病房和延长住院时间,我们建议在联合RA (CRA)下逆行腹膜外RC作为手术干预的首选方法,适用于腹部脏器功能障碍小、肠道恢复早的高危老年患者。
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来源期刊
Urological Science
Urological Science UROLOGY & NEPHROLOGY-
CiteScore
1.20
自引率
0.00%
发文量
26
审稿时长
6 weeks
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