原位U型回肠新膀胱机器人辅助根治性膀胱切除术术后增强恢复方案的实施

Q4 Medicine

中华泌尿外科杂志 Pub Date : 2020-02-15 DOI:10.3760/CMA.J.ISSN.1000-6702.2020.02.004

Q. Wo, X. Qi, Feng Liu, Qi Zhang, Zujie Mao, Fei Xiang, Jia Lyu, Linyi Hu, Liping Wang, Xiang He, Da-hong Zhang

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The median age-adjusted charlson comorbidity index(aCCI) was 4, median ASA score was 2. All patients underwent these inspections pre-RARC: chest Xray, vascular ultrasound(jugular vein included), abdominal ultrasound, CT urography, cystoscopy with biopsy or TURBT(trans-urethral resection of a bladder tumour). All patients were pathological diagnosed with MIBC, with no evidence of systemic metastasis and no history of radiotherapy, systemic chemotherapy and open abdominal surgery before RARC. All 71 patients received RARC with intracorporeal orthotopic \"U\" shaped ileal neobladder creation using STAPLER technique. Between October 2014 and September 2016, 37 cases(29 males and 8 females) were managed without ERAS protocols perioperatively. They had an average age of (65.3±5.7)y and BMI of (23.66±3.47)kg/m2. The median aCCI was 4, median ASA score was 2. Between October 2016 and April 2019, another group of 34 cases (30 males and 4 females) were managed with ERAS protocols including nutritional assessment, thrombosis prevention, pain assessment and management, perioperative diet management etc. They had an average age of (64.5±4.3)y and BMI of (21.87±4.85)kg/m2. The median aCCI was 4, median ASA score was 2. There were no statistical significance between the two groups with regard to general information. Surgical and follow-up data were collected for all patients. \n \n \nResults \nSurgeries were successful in all 71 cases with postoperative follow up for 3-51 months. In ERAS group, there were 22 cases in pT2 and 12 cases pT3 according to classification of malignant tumours: with 2 cases of incidental prostate cancer (IPCa). In non-ERAS group, pT2 in 25 cases and pT3 in 12 cases: with 1 case of IPCa. Statistical significance were observed between groups with regard to the first anal exhaust time [(20.5±18.7)h vs.(29.9±17.4)h, P=0.032], the first defecation time [(72.6±27.1)h vs.(88.7±35.8)h, P=0.004], length of hospital stay after surgey [(14.1±3.3)d vs.(16.2±4.8)d, P=0.037], numeric rating scales (NRS) Pain Score 8.0, 24.0, 48.0 h after surgery [(3.2±0.5)vs.(3.6±0.8), P=0.015; (1.9±0.3)vs.(2.2±0.6), P=0.011; (1.3±0.4)vs.(1.6±0.7), P=0.032], respectively. There were no significance between groups with regard to operating time [(290±65)min vs.(282±46)min, P=0.549], intraoperative blood loss [(190.5±235.6)ml vs.(221.1±250.3)ml, P=0.438], transfusion rate [5.9%(2/34)vs. 8.1%(3/37), P=0.922], readmission within 30 days after surgery [2.9%(1/34)vs. 5.4%(2/37), P=0.940], early severe complications(within 30 days) [2.9%(1/34)vs. 2.7%(1/37), P=0.940], late severe complications (after 30 days) [5.9%(2/34)vs. 8.1%(3/37), P=0.922]. \n \n \nConclusions \nThe implementation of ERAS protocols to patients who underwent RARC with intracorporeal orthotopic \"U\" shaped ileal neobladder using STAPLER technique is safe and effective. It can reduce postoperative pain and hospital stay, shorten bowel recovery time, improve early functional recovery without increasing major complications. 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Qi, Feng Liu, Qi Zhang, Zujie Mao, Fei Xiang, Jia Lyu, Linyi Hu, Liping Wang, Xiang He, Da-hong Zhang\",\"doi\":\"10.3760/CMA.J.ISSN.1000-6702.2020.02.004\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Objective \\nTo discuss outcome and safety after implementation of enhanced recovery after surgery(ERAS) protocols to patients who underwent robotic assisted radical cystectomy(RARC) with intracorporeal orthotopic \\\"U\\\" shaped ileal neobladder creation using STAPLER technique. \\n \\n \\nMethods \\nBetween October 2014 and April 2019, 71 patients(59 males and 12 females)with MIBC(Muscle Invasive Bladder Cancer) who underwent RARC with intracorporeal urinary diversion using orthotopic \\\"U\\\" shaped ileal neobladder in Zhejiang Provincial People's Hospital(People's Hospital of Hangzhou Medical College)were studied retrospectively. They had an average age of (65.2±5.6)y and BMI of (22.18±3.75)kg/m2. The median age-adjusted charlson comorbidity index(aCCI) was 4, median ASA score was 2. All patients underwent these inspections pre-RARC: chest Xray, vascular ultrasound(jugular vein included), abdominal ultrasound, CT urography, cystoscopy with biopsy or TURBT(trans-urethral resection of a bladder tumour). All patients were pathological diagnosed with MIBC, with no evidence of systemic metastasis and no history of radiotherapy, systemic chemotherapy and open abdominal surgery before RARC. All 71 patients received RARC with intracorporeal orthotopic \\\"U\\\" shaped ileal neobladder creation using STAPLER technique. Between October 2014 and September 2016, 37 cases(29 males and 8 females) were managed without ERAS protocols perioperatively. They had an average age of (65.3±5.7)y and BMI of (23.66±3.47)kg/m2. The median aCCI was 4, median ASA score was 2. Between October 2016 and April 2019, another group of 34 cases (30 males and 4 females) were managed with ERAS protocols including nutritional assessment, thrombosis prevention, pain assessment and management, perioperative diet management etc. They had an average age of (64.5±4.3)y and BMI of (21.87±4.85)kg/m2. The median aCCI was 4, median ASA score was 2. There were no statistical significance between the two groups with regard to general information. Surgical and follow-up data were collected for all patients. \\n \\n \\nResults \\nSurgeries were successful in all 71 cases with postoperative follow up for 3-51 months. In ERAS group, there were 22 cases in pT2 and 12 cases pT3 according to classification of malignant tumours: with 2 cases of incidental prostate cancer (IPCa). In non-ERAS group, pT2 in 25 cases and pT3 in 12 cases: with 1 case of IPCa. Statistical significance were observed between groups with regard to the first anal exhaust time [(20.5±18.7)h vs.(29.9±17.4)h, P=0.032], the first defecation time [(72.6±27.1)h vs.(88.7±35.8)h, P=0.004], length of hospital stay after surgey [(14.1±3.3)d vs.(16.2±4.8)d, P=0.037], numeric rating scales (NRS) Pain Score 8.0, 24.0, 48.0 h after surgery [(3.2±0.5)vs.(3.6±0.8), P=0.015; (1.9±0.3)vs.(2.2±0.6), P=0.011; (1.3±0.4)vs.(1.6±0.7), P=0.032], respectively. 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引用次数: 0

摘要

目的探讨应用STAPLER技术进行机器人辅助膀胱根治术（RARC）患者术后增强恢复（ERAS）方案的效果和安全性。方法回顾性分析2014年10月至2019年4月，浙江省人民医院（杭州医学院人民医院）71例（男59例，女12例）癌症（MIBC）患者采用原位“U”形回肠新膀胱行RARC行体内导尿术的临床资料。他们的平均年龄为（65.2±5.6）y，BMI为（22.18±3.75）kg/m2。年龄调整后的charlson合并症指数（aCCI）中位数为4，ASA评分中位数为2。所有患者在RARC前都接受了这些检查：胸部X光、血管超声（包括颈静脉）、腹部超声、CT泌尿系造影、膀胱镜检查和活检或TURBT（膀胱肿瘤经尿道切除术）。所有患者均被病理诊断为MIBC，没有全身转移的证据，在RARC之前也没有放疗、全身化疗和腹部直视手术史。所有71例患者均接受了RARC，并使用STAPLER技术进行了原位“U”形回肠新膀胱造瘘。2014年10月至2016年9月，37例（29名男性和8名女性）在没有ERAS方案的情况下进行了围手术期治疗。他们的平均年龄为（65.3±5.7）y，BMI为（23.66±3.47）kg/m2。aCCI中位数为4，ASA中位数为2。2016年10月至2019年4月，另一组34例患者（30名男性和4名女性）接受了ERAS方案治疗，包括营养评估、血栓预防、疼痛评估和管理、围手术期饮食管理等。他们的平均年龄为（64.5±4.3）y，BMI为（21.87±4.85）kg/m2。aCCI中位数为4，ASA中位数为2。在一般信息方面，两组之间没有统计学意义。收集所有患者的手术和随访数据。结果71例患者均成功，术后随访3～51个月。在ERAS组中，根据恶性肿瘤的分类，pT2和pT3分别有22例和12例：其中2例为偶发性前列腺癌症（IPCa）。在非ERAS组中，pT2在25例中，pT3在12例中：其中1例为IPCa。两组在第一次肛门排气时间[（20.5±18.7）h与（29.9±17.4）h，P=0.032]、第一次排便时间[（72.6±27.1）h和（88.7±35.8）h，P=0.004]、手术后住院时间[（14.1±3.3）d与（16.2±4.8）d，P=0.037]、数字评定量表（NRS）疼痛评分8.0，24.0，术后48.0小时[分别为（3.2±0.5）vs.（3.6±0.8），P=0.015；（1.9±0.3）vs。两组之间在手术时间[（290±65）分钟对（282±46）分钟，P=0.549]、术中失血[（190.5±235.6）ml对（221.1±250.3）ml，P=0.438]、输血率[5.9%（2/34）对8.1%（3/37），P=0.922]、术后30天内再次入院[2.9%（1/34）对5.4%（2/37），P=0.0940]、早期严重并发症（30天内）[2.9%，晚期严重并发症（30天后）[5.9%（2/34）vs.8.1%（3/37），P=0.922]。结论采用STAPLER技术对接受RARC的患者实施ERAS方案是安全有效的。它可以减少术后疼痛和住院时间，缩短肠道恢复时间，改善早期功能恢复，而不会增加重大并发症。应该鼓励这种采用。关键词：膀胱肿瘤；术后恢复增强（ERAS）；膀胱癌症；纯机器人辅助；根治性膀胱切除术；围手术期；原位U型回肠新膀胱

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Implementation of enhanced recovery after surgery protocols to robotic assisted radical cystectomy with intracorporeal urinary diversion using orthotopic U-shape ileal neobladder

Objective To discuss outcome and safety after implementation of enhanced recovery after surgery(ERAS) protocols to patients who underwent robotic assisted radical cystectomy(RARC) with intracorporeal orthotopic "U" shaped ileal neobladder creation using STAPLER technique. Methods Between October 2014 and April 2019, 71 patients(59 males and 12 females)with MIBC(Muscle Invasive Bladder Cancer) who underwent RARC with intracorporeal urinary diversion using orthotopic "U" shaped ileal neobladder in Zhejiang Provincial People's Hospital(People's Hospital of Hangzhou Medical College)were studied retrospectively. They had an average age of (65.2±5.6)y and BMI of (22.18±3.75)kg/m2. The median age-adjusted charlson comorbidity index(aCCI) was 4, median ASA score was 2. All patients underwent these inspections pre-RARC: chest Xray, vascular ultrasound(jugular vein included), abdominal ultrasound, CT urography, cystoscopy with biopsy or TURBT(trans-urethral resection of a bladder tumour). All patients were pathological diagnosed with MIBC, with no evidence of systemic metastasis and no history of radiotherapy, systemic chemotherapy and open abdominal surgery before RARC. All 71 patients received RARC with intracorporeal orthotopic "U" shaped ileal neobladder creation using STAPLER technique. Between October 2014 and September 2016, 37 cases(29 males and 8 females) were managed without ERAS protocols perioperatively. They had an average age of (65.3±5.7)y and BMI of (23.66±3.47)kg/m2. The median aCCI was 4, median ASA score was 2. Between October 2016 and April 2019, another group of 34 cases (30 males and 4 females) were managed with ERAS protocols including nutritional assessment, thrombosis prevention, pain assessment and management, perioperative diet management etc. They had an average age of (64.5±4.3)y and BMI of (21.87±4.85)kg/m2. The median aCCI was 4, median ASA score was 2. There were no statistical significance between the two groups with regard to general information. Surgical and follow-up data were collected for all patients. Results Surgeries were successful in all 71 cases with postoperative follow up for 3-51 months. In ERAS group, there were 22 cases in pT2 and 12 cases pT3 according to classification of malignant tumours: with 2 cases of incidental prostate cancer (IPCa). In non-ERAS group, pT2 in 25 cases and pT3 in 12 cases: with 1 case of IPCa. Statistical significance were observed between groups with regard to the first anal exhaust time [(20.5±18.7)h vs.(29.9±17.4)h, P=0.032], the first defecation time [(72.6±27.1)h vs.(88.7±35.8)h, P=0.004], length of hospital stay after surgey [(14.1±3.3)d vs.(16.2±4.8)d, P=0.037], numeric rating scales (NRS) Pain Score 8.0, 24.0, 48.0 h after surgery [(3.2±0.5)vs.(3.6±0.8), P=0.015; (1.9±0.3)vs.(2.2±0.6), P=0.011; (1.3±0.4)vs.(1.6±0.7), P=0.032], respectively. There were no significance between groups with regard to operating time [(290±65)min vs.(282±46)min, P=0.549], intraoperative blood loss [(190.5±235.6)ml vs.(221.1±250.3)ml, P=0.438], transfusion rate [5.9%(2/34)vs. 8.1%(3/37), P=0.922], readmission within 30 days after surgery [2.9%(1/34)vs. 5.4%(2/37), P=0.940], early severe complications(within 30 days) [2.9%(1/34)vs. 2.7%(1/37), P=0.940], late severe complications (after 30 days) [5.9%(2/34)vs. 8.1%(3/37), P=0.922]. Conclusions The implementation of ERAS protocols to patients who underwent RARC with intracorporeal orthotopic "U" shaped ileal neobladder using STAPLER technique is safe and effective. It can reduce postoperative pain and hospital stay, shorten bowel recovery time, improve early functional recovery without increasing major complications. This adoption should be encouraged. Key words: Urinary bladder neoplasms; Enhanced recovery after surgery(ERAS); Urinary bladder cancer; Pure robotic-assisted; Radical cystectomy; Perioperative; Orthotopic U-shape ileal neobladder

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来源期刊

中华泌尿外科杂志 Medicine-Nephrology

CiteScore

0.10

自引率

0.00%

发文量

14180

期刊介绍： Chinese Journal of Urology (monthly) was founded in 1980. It is a publicly issued academic journal supervised by the China Association for Science and Technology and sponsored by the Chinese Medical Association. It mainly publishes original research papers, reviews and comments in this field. This journal mainly reports on the latest scientific research results and clinical diagnosis and treatment experience in the professional field of urology at home and abroad, as well as basic theoretical research results closely related to clinical practice. The journal has columns such as treatises, abstracts of treatises, experimental studies, case reports, experience exchanges, reviews, reviews, lectures, etc. Chinese Journal of Urology has been included in well-known databases such as Peking University Journal (Chinese Journal of Humanities and Social Sciences), CSCD Chinese Science Citation Database Source Journal (including extended version), and also included in American Chemical Abstracts (CA). The journal has been rated as a quality journal by the Association for Science and Technology and as an excellent journal by the Chinese Medical Association.