D. Perlin, I. Aleksandrov, A. Shmanev, Sh. Shamhalov, P. Kulikov
{"title":"腹腔镜腹膜外根治性前列腺膀胱切除术:为谁而做,如何做?","authors":"D. Perlin, I. Aleksandrov, A. Shmanev, Sh. Shamhalov, P. Kulikov","doi":"10.17650/1726-9776-2023-19-3-69-78","DOIUrl":null,"url":null,"abstract":"Background. Laparoscopic radical cystectomy is an established reliable minimally invasive method for the treatment of muscle-invasive bladder cancer. However, in the elderly and patients with serious comorbidities, laparoscopic radical cystectomy is still associated with high risk of complications. There are only a few reports on the use of extraperitoneal access for laparoscopic radical cystectomy in the literature. At the same time, extensive experience has been accumulated in laparoscopic extraperitoneal radical prostatectomy and retroperitoneoscopic operations on the kidney showing significant advantages of extraperitoneal access. Aim. To present initial results of laparoscopic radical cystectomy through extraperitoneal access in medically ill patients.Materials and methods. Between 2017 and 2021, extraperitoneal laparoscopic radical cystectomy was performed at the Volgograd Regional Uronephrology Center in four male patients with tumors affecting the bladder, stages T2–T4. All patients had serious comorbidities. In 3 patients, grade G2–G3 muscle-invasive bladder cancer was histologically verified prior to cystectomy. Two of them had invasion in the posterior urethra. One patient was diagnosed with prostate adenocarcinoma (Gleason score 8 (5 + 3)) with invasion into the bladder wall, ureterohydronephrosis and stage IV chronic kidney disease. None of the patients received neoadjuvant therapy: in 2 cases surgeries were emergency due to recurrent hemorrhages, and 3 patients had significantly decreased kidney function.Results. All operations were performed completely laparoscopically through extraperitoneal access. In 1 case, urine diversion was performed transperitoneally into a colon conduit. Simultaneous retroperitoneoscopic ureterocutaneostomy was performed in two patients: on one side (in a patient with a single functioning kidney) and on both sides, respectively. In a patient with stage V chronic kidney disease and permanent dialysis, bilateral simultaneous retroperitoneal nephrectomies were performed.In 2 patients, salvage cystectomy was done for recurrent bleeding that couldn’t be managed by conservative methods. The maximum intraoperative blood loss did not exceed 500 mL. Bowel function in all patients was recovered within 24–36 hours after the intervention.Conclusion. Laparoscopic extraperitoneal radical cystectomy is a reproducible minimally invasive surgical procedure for bladder cancer treatment that has advantages in terms of postoperative recovery in patients with severe comorbidities. The use of extraperitoneal access may be a rational alternative for salvage cystectomy in male patients. More observations are needed to determine the place of the method in the surgical treatment of muscle invasive bladder cancer.","PeriodicalId":216890,"journal":{"name":"Cancer Urology","volume":"36 5","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Laparoscopic extraperitoneal radical cystoprostatectomy: for whom and how?\",\"authors\":\"D. Perlin, I. Aleksandrov, A. Shmanev, Sh. Shamhalov, P. Kulikov\",\"doi\":\"10.17650/1726-9776-2023-19-3-69-78\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Background. Laparoscopic radical cystectomy is an established reliable minimally invasive method for the treatment of muscle-invasive bladder cancer. However, in the elderly and patients with serious comorbidities, laparoscopic radical cystectomy is still associated with high risk of complications. There are only a few reports on the use of extraperitoneal access for laparoscopic radical cystectomy in the literature. At the same time, extensive experience has been accumulated in laparoscopic extraperitoneal radical prostatectomy and retroperitoneoscopic operations on the kidney showing significant advantages of extraperitoneal access. Aim. To present initial results of laparoscopic radical cystectomy through extraperitoneal access in medically ill patients.Materials and methods. Between 2017 and 2021, extraperitoneal laparoscopic radical cystectomy was performed at the Volgograd Regional Uronephrology Center in four male patients with tumors affecting the bladder, stages T2–T4. All patients had serious comorbidities. In 3 patients, grade G2–G3 muscle-invasive bladder cancer was histologically verified prior to cystectomy. Two of them had invasion in the posterior urethra. One patient was diagnosed with prostate adenocarcinoma (Gleason score 8 (5 + 3)) with invasion into the bladder wall, ureterohydronephrosis and stage IV chronic kidney disease. None of the patients received neoadjuvant therapy: in 2 cases surgeries were emergency due to recurrent hemorrhages, and 3 patients had significantly decreased kidney function.Results. All operations were performed completely laparoscopically through extraperitoneal access. In 1 case, urine diversion was performed transperitoneally into a colon conduit. Simultaneous retroperitoneoscopic ureterocutaneostomy was performed in two patients: on one side (in a patient with a single functioning kidney) and on both sides, respectively. In a patient with stage V chronic kidney disease and permanent dialysis, bilateral simultaneous retroperitoneal nephrectomies were performed.In 2 patients, salvage cystectomy was done for recurrent bleeding that couldn’t be managed by conservative methods. The maximum intraoperative blood loss did not exceed 500 mL. Bowel function in all patients was recovered within 24–36 hours after the intervention.Conclusion. Laparoscopic extraperitoneal radical cystectomy is a reproducible minimally invasive surgical procedure for bladder cancer treatment that has advantages in terms of postoperative recovery in patients with severe comorbidities. The use of extraperitoneal access may be a rational alternative for salvage cystectomy in male patients. More observations are needed to determine the place of the method in the surgical treatment of muscle invasive bladder cancer.\",\"PeriodicalId\":216890,\"journal\":{\"name\":\"Cancer Urology\",\"volume\":\"36 5\",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-11-16\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Cancer Urology\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.17650/1726-9776-2023-19-3-69-78\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cancer Urology","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.17650/1726-9776-2023-19-3-69-78","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景。腹腔镜根治性膀胱切除术是治疗肌肉浸润性膀胱癌的可靠微创方法。然而,对于老年人和有严重合并症的患者,腹腔镜根治性膀胱切除术仍有较高的并发症风险。关于腹膜外入路用于腹腔镜根治性膀胱切除术的文献报道寥寥无几。与此同时,腹腔镜腹膜外前列腺癌根治术和后腹腔镜肾脏手术已积累了丰富的经验,显示出腹膜外入路的显著优势。目的介绍在内科病人中通过腹膜外入路进行腹腔镜根治性膀胱切除术的初步结果。2017年至2021年期间,伏尔加格勒地区泌尿外科中心为四名膀胱肿瘤T2-T4期男性患者实施了腹膜外腹腔镜根治性膀胱切除术。所有患者都有严重的并发症。其中 3 名患者的 G2-G3 级肌肉浸润性膀胱癌已在膀胱切除术前得到组织学证实。其中两人的后尿道受到侵犯。一名患者被诊断为前列腺腺癌(Gleason 评分 8(5 + 3)),并伴有膀胱壁侵犯、输尿管肾积水和 IV 期慢性肾病。所有患者均未接受新辅助治疗:2例患者因反复出血而紧急手术,3例患者肾功能明显下降。所有手术均通过腹膜外入路在腹腔镜下完成。在1例患者中,经腹膜将尿液导入结肠导管。两名患者分别在一侧(单肾功能患者)和两侧同时进行了后腹腔镜输尿管造口术。在一名患有慢性肾脏病 V 期和永久性透析的患者身上,同时进行了双侧腹膜后肾切除术。在两名患者身上,由于保守方法无法控制的复发性出血,进行了挽救性膀胱切除术。术中最大失血量不超过 500 毫升。所有患者的肠道功能均在术后 24-36 小时内恢复。腹腔镜腹膜外膀胱根治术是一种可重复的膀胱癌微创手术治疗方法,对有严重合并症的患者的术后恢复具有优势。使用腹膜外入路可能是男性患者进行挽救性膀胱切除术的合理选择。要确定该方法在肌层浸润性膀胱癌手术治疗中的地位,还需要更多的观察。
Laparoscopic extraperitoneal radical cystoprostatectomy: for whom and how?
Background. Laparoscopic radical cystectomy is an established reliable minimally invasive method for the treatment of muscle-invasive bladder cancer. However, in the elderly and patients with serious comorbidities, laparoscopic radical cystectomy is still associated with high risk of complications. There are only a few reports on the use of extraperitoneal access for laparoscopic radical cystectomy in the literature. At the same time, extensive experience has been accumulated in laparoscopic extraperitoneal radical prostatectomy and retroperitoneoscopic operations on the kidney showing significant advantages of extraperitoneal access. Aim. To present initial results of laparoscopic radical cystectomy through extraperitoneal access in medically ill patients.Materials and methods. Between 2017 and 2021, extraperitoneal laparoscopic radical cystectomy was performed at the Volgograd Regional Uronephrology Center in four male patients with tumors affecting the bladder, stages T2–T4. All patients had serious comorbidities. In 3 patients, grade G2–G3 muscle-invasive bladder cancer was histologically verified prior to cystectomy. Two of them had invasion in the posterior urethra. One patient was diagnosed with prostate adenocarcinoma (Gleason score 8 (5 + 3)) with invasion into the bladder wall, ureterohydronephrosis and stage IV chronic kidney disease. None of the patients received neoadjuvant therapy: in 2 cases surgeries were emergency due to recurrent hemorrhages, and 3 patients had significantly decreased kidney function.Results. All operations were performed completely laparoscopically through extraperitoneal access. In 1 case, urine diversion was performed transperitoneally into a colon conduit. Simultaneous retroperitoneoscopic ureterocutaneostomy was performed in two patients: on one side (in a patient with a single functioning kidney) and on both sides, respectively. In a patient with stage V chronic kidney disease and permanent dialysis, bilateral simultaneous retroperitoneal nephrectomies were performed.In 2 patients, salvage cystectomy was done for recurrent bleeding that couldn’t be managed by conservative methods. The maximum intraoperative blood loss did not exceed 500 mL. Bowel function in all patients was recovered within 24–36 hours after the intervention.Conclusion. Laparoscopic extraperitoneal radical cystectomy is a reproducible minimally invasive surgical procedure for bladder cancer treatment that has advantages in terms of postoperative recovery in patients with severe comorbidities. The use of extraperitoneal access may be a rational alternative for salvage cystectomy in male patients. More observations are needed to determine the place of the method in the surgical treatment of muscle invasive bladder cancer.