Fifteen years of experience radical cystectomy and intestinal urinary diversion

Objective. Examination of the results of surgical treatment and analysis of the surgical technique and perioperative parameters in a series of radical cystectomy on the basis of its own 15 years of experience in the formation of orthotopic and heterotopic urinary reservoir of the ileum segment by developed and patented techniques in different versions: open radical cystectomy, laparoscopic radical cystectomy and robotassisted radical cystectomy.

Materials and methods. A retrospective analysis of 310 radical cystectomy performed from 2000 to 2015, on the occasion of various pathologies of the bladder and prostate, as well as cancers of other organs (uterus, colon) with involvement in the process of bladder tumor. Plastics of the bladder was performed from the segment of the terminal ileum. Formation of orthotopic bladder was performed by the method of M.I. Vasilchenko (RF patent for invention № 2337630 “Method of orthotopic bladder plastics” by M.I. Vasilchenko). The ureters are implanted by antireflux procedure. If unable to perform orthotopic bladder plastics recovery and self-urination, patients underwent the formation of heterotopic enteral reservoir with a holding valve.

Results. It assesses the functionality and viability of organic shaped orthotopic and heterotopic urinary neocystis in the early and late postoperative periods in different versions. The proposed techniques have a beneficial effect on the improvement of the functional state and stabilization of the upper urinary tract. Analysis of morbidity and mortality was determined according to the classification of surgical complications on the Clavien–Dindo. This approach allowed to identify most of the complications and prevent an underestimation of the main negative results. Estimated oncologic efficacy of minimally invasive interventions laparoscopic radical cystectomy and robot-assisted radical cystectomy not inferior open radical cystectomy.

Conclusions. Formation of heterotopic and orthotopic bladder enteral neocystis (tank), on the proposed contact techniques is a viable alternative to the known intestinal plastics. The introduction of laparoscopic surgery techniques including robot-assisted laparoscopic operations to reduce the number of early and late postoperative complications. 

1. Матвеев В.Б., Волкова М.И., Медведев С.В. и др. Клинические рекомендации по диагностике и лечению больных раком мочевого пузыря. Ассоциация онкологов России. М., 2014. С. 3. [Matveev V.B., Volkova M.I., Medvedev S.V. et al. Clinical guidelines for the diagnosis and treatment of patients with bladder cancer. Russian Association of Oncologists. Мoscow, 2014. Р. 3. (In Russ.)].

2. Матвеев В.Б., Волкова М.И., Фигурин К.М., Петерс М.В. Спасительная цистэктомия у больных переходноклеточным раком мочевого пузыря. Онкоурология 2009;5(1):27–31. [Matveev V.B., Volkova M.I., Figurin K.M., Peters M.V. Sparing cystectomy in patients with transitional-cell carcinoma of the urinary bladder. Onkourologiya = Oncourology 2009;5(1):27–31. (In Russ.)]. DOI: 10.17650/1726-9776-2009-5-1-27-31.

3. Springer C., Mohammed N., Alba S. et al. Laparoscopic radical cystectomy with extracorporeal ileal neobladder for muscleinvasive urothelial carcinoma of the bladder: technique and short-term outcomes. World J Urol 2014;32(2):407–12. DOI: 10.1007/s00345-013-1122-3. PMID: 23817890.

4. Collins J.W., Wiklund P.N., Desai M.M. et al. Total intracorporeal robotic cystectomyare we there yet? Curr Opin Urol 2013;23(2):135–40. DOI: 10.1097/MOU.0b013e32835d4cda. PMID: 23357930.

5. Bochner B.H., Sjoberg D.D., Laudone V.P. et al. A randomized trial of robot-assisted laparoscopic radical cystectomy. N Engl J Med 2014;371(4):389–90. DOI: 10.1056/NEJMc1405213. PMID: 25054732.

6. Nix J., Smith A., Kurpad R. et al. Prospective randomized controlled trial of robotic versus open radicalcystectomy for bladder cancer: perioperative and pathologic results. Eur Urol 2010;57(2):196–201. DOI: 10.1016/j.eururo.2009.10.024. PMID: 19853987.

7. Parekh D.J., Messer J., Fitzgerald J. et al. Perioperative outcomes andoncologic efficacy from a pilot prospective randomized clinical trial of open versusrobotic assisted radical cystectomy. J Urol 2013;189:474–9.

8. Smith A.B., Raynor M., Amling C.L. et al. Multi-institutional analysis of robotic radical cystectomy for bladder cancer: Perioperative outcomes and complications in 227 patients. J Laparoendosc Adv Surg Tech A 2012;22(1):17–21. DOI: 10.1089/lap.2011.0326. PMID: 22142028.

9. Fergany A.F. Laparoscopic radical cystectomy. Arab J Urology 2012;10(1):40–5. DOI: 10.1016/j.aju.2012.01.003. PMID: 26558003.

10. Патент № 2337630 Российская Федерация, МПК A61B17/00. Способ ортотопической тонкокишечной пластики мочевого пузыря. М.И. Васильченко. Заявлено 04.05.2007, опубликовано 10.11.2008, Бюллетень № 4. 9 с. [Patent № 2337630 Russian Federation, MPK A61V17/00. Method of orthotopic small-intestinal plastic surgery of the bladder. M.I. Vasilchenko. Filed on 04.05.2007, published on 10.11.2008, Bulletin № 4. 9 p. (In Russ.)].

11. Dindo D., Demartines N., Clavien P.A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240(2):205–13. PMID: 15273542.

12. Даренков С.П., Ковалев В.А., Очархаджиев С.Б. Кишечное замещение мочевого пузыря с формированием континентной кутанеостомы. Урология 2006;(1):33–8. [Darenkov S.P., Kovalev V.А., Оcharkhadzhiev S.B. Intestinal substitution of the bladder with the formation of the cutaneostona. Urologiya = Urology 2006;(1):33–8. (In Russ.)].

13. Knox M.L., El-Galley R., Busby J.E. Robotic versus open radical cystectomy: identification of patients who benefit from the robotic approach. J Endourol 2013;27(1):40–4. DOI: 10.1089/end.2012.0168. PMID: 22788707.

14. Bochner B.H., Sjoberg D.D., Laudone V.P. et al. A randomized trial of robot-assisted laparoscopic radical cystectomy. N Engl J Med 2014;371(4):389–90. DOI: 10.1056/NEJMc1405213. PMID: 25054732.

15. Ahmed K., Khan S.A., Hayn M.H. et al. Analysis of intracorporeal compared with extracorporeal urinary diversion after robotassisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol 2014;65(2):340–7. DOI: 10.1016/j.eururo.2013.09.042. PMID: 24183419.

16. Nix J., Smith A., Kurpad R. et al. Prospective randomized controlled trial of robotic versus open radicalcystectomy for bladder cancer: perioperative and pathologic results. Eur Urol 2010;57(2):196–201. DOI: 10.1016/j.eururo.2009.10.024. PMID: 19853987.

17. Hermans T.J., Fossion L.M. What about conventional laparoscopic radical cystectomy? Cost-analysis of open versus laparoscopic radical cystectomy. J Endourol 2014;28(4):410–5. DOI: 10.1089/end.2013.0550. PMID: 24156714.

18. Перепечай А.В., Васильев О.Н., Спицын И.М., Коган М.И. Предикторы морбидности радикальной цистэктомии и различных вариантов уродеривации: 20-летний опыт одного хирургического центра. Онкоурология 2016;12(1):42–57. [Perepechay V.A., Vasil’ev O.N., Spitsyn I.M., Kogan M.I. Predictors for morbidity of radical cystectomy and different types of urine derivation: 20-year experience of a surgery center. Onkourologiya = Cancer Urology 2016;12(1):42–57. (In Russ.)]. DOI:10.17650/1726-9776-2016-12-1-42-57.

19. Tyritzis S.I., Hosseini A., Collins J. et al. Oncologic, functional, and complications outcomes of robot-assisted radical cystectomy with totally intracorporeal neobladder diversion. Eur Urol 2013;64(5):734–41. DOI: 10.1016/j.eururo.2013.05.050. PMID: 23768634.

20. Chade D.C., Laudone V.P., Bochner B.H. et al. Oncological outcomes after radical cystectomy for bladder cancer: open versus minimally invasive approaches. J Urol 2010;183(3):862–9. DOI: 10.1016/j.juro.2009.11.019. PMID: 20083269.

21. Abaza R., Dangle P.P., Gong M.C. et al. Quality of lymphadenectomy is equivalent with robotic and open cystectomy using an extended template. J Urol 2012;187(4):1200–4. DOI: 10.1016/j.juro.2011.11.092. PMID: 22341295.

22. Abraham J.B.A., Young J.L., Box G.N. et al. Comparative analysis of laparoscopic and robot-assisted radical cystectomy with ileal conduit urinary diversion. J Endourol 2007;21(12): 1473–80. DOI: 10.1089/end.2007.0095. PMID: 18186686.