Cancer UrologyCancer UrologyОнкоурология1726-97761996-1812Publishing House ABV Press49110.17650/1726-9776-2015-11-3-71-78DIAGNOSIS AND TREATMENT OF URINARY SYSTEM TUMORS. URINARY BLADDER CANCERДИАГНОСТИКА И ЛЕЧЕНИЕ ОПУХОЛЕЙ МОЧЕПОЛОВОЙ СИСТЕМЫ. Рак мочевого пузыряRadical cystectomy for bladder cancer: сomparison of early surgical complications during laparoscopic, open-access, and video-assisted surgeryРадикальная цистэктомия при раке мочевого пузыря: сравнение ранних хирургических осложнений при лапароскопической, открытой и видеоассистированой операцииNosovA. K.НосовА. К.
Russian Federation
RevaS. A.РеваС. А.
Russian Federation
sgreva79@mail.ruDzhalilovI. B.ДжалиловИ. Б.
Russian Federation
PetrovS. B.ПетровС. Б.
Russian Federation
Department of Urologic Oncology, N. N. Petrov Research Institute of Oncology, Ministry of Health of RussiaОтделение онкоурологии ФГБУ «НИИ онкологии Н. Н. Петрова» Минздрава России68 Leningradskaya St., Pesochnyi Settlement, Saint Petersburg, 197 758, RussiaРоссия, 197758, Санкт-Петербург, пос. Песочный, ул. Ленинградская, 683009201511371782409201524092015https://oncourology.abvpress.ru/oncur/article/view/491

Objectives. To evaluate peri- and postoperative morbidity and functional results of LRC in a single-site cohort of patients, comparing it with standard open approach (ORC) and laparoscopic cystectomy with open urinary diversion (HALRC).

Subjects and methods. A prospective analysis was performed in 51 muscle-invasive and locally advanced BCa patients who underwent RC between February 2012 and March 2014 in N. N. Petrov Research Institute of Oncology, Saint-Petersburg. The final cohort included 21 ORC, 21 LRC and 9 HALRC patients. Mean patients age was 64 (38–81) years old and did not differ in all groups. Pathological stage were similar in all groups. Multivariable logistic and median regression was performed to evaluate operating time, perioperative and postoperative complications (30-d and 90-d), readmission rates, length of stay (LOS) – totally and in ICU.

Results. Operating time during LRC and HALRC was longer than that of ORC (398 min vs 468 min vs 243 min, respectively). Despite that, there was no statistically significant influence of type of surgery on intraoperative complications – 14.3 % in ORC group, 11.1 % in HALRC and 4.7 % in LRC patients. Major complication rates (Clavien grade  3; 23.8 % vs 33.3 % vs 19.4 %) were similar between all groups. However, LRC had 4,0 times lower rate of minor complications (Clavien grade 1–2) compared to ORC (4.7 % vs 19.0 %). LRC had a significantly shorter LOS (27.8 d vs 32.6 d vs 22.6 d in ORC, HALRC and LRC groups, respectively), but no significant differences in ICU stay existed (5.1 d vs 3.1 d vs 2.1 d). Morbidity were present by one patient in each group (medium rate 5,8 %). The common transfusion rate during and after surgical intervention was 19.6 % and was higher in ORC group (33.3 % vs 4.7 % in LRC); as well, intraoperative bleeding was lower in minimally invasive techniques – the average volume of blood loss was 285 ml in LRC and did not differ between HALRC and ORC groups – 468 and 577 ml, respectively. Depending on the timing of complications, there were 30-d complications in 19 patients (37,2 %) and 90-d in 27 (52,9 %). The greatest difference was observed between any grade gastrointectinal complications (foremost, ileus) with significantly better outcomes in LRC patients – 14.2 %, compared with 47.6 % and 55 % in ORC and HALRC, respectively.

Conclusions. We found that LRC is safe and associated with lower blood loss, decreased postoperative ileus and lower LOS compared with ORC. Using a population-based cohort, we found that laparoscopic surgery for bladder cancer decreased minor complications (mainly due to lower bleeding and gastrointestinal complication rate) and had no impact on major complications.

Цель исследования – сравнение частоты интраоперационных и послеоперационных осложнений при выполнении радикальной цистэктомии (РЦЭ) – лапароскопической (ЛЦЭ), видеоассистированной (ВАЦЭ) и открытой (ОЦЭ) – у больных раком мочевого пузыря (РМП).

Материалы и методы. Нами проведен проспективный анализ результатов лечения 51 больного с мышечно-инвазивным и местно-распространенным РМП, которым была выполнена РЦЭ в период с февраля 2012 по март 2014 г. в отделении онкоурологии НИИонкологии им. Н. Н. Петрова (Санкт-Петербург). Открытая операция выполнена 21 пациенту, такому же числу – лапароскопическое вмешательство и еще 9 больным – ВАЦЭ. Средний возраст пациентов составил 64 (38–81) года и был сопоставим во всех группах, так же как и патологическая стадия. Проведен анализ продолжительности операции, частоты интраоперационных и послеоперационных (в течение 30- и 90-дневного периода) осложнений, частоты повторных поступлений, длительности нахождения в стационаре – общей и в отделении реанимации.

Результаты. Длительность операции при ЛЦЭ и ВАЦЭ была больше, чем при ОЦЭ (соответственно 398, 468 и 243 мин). Не отмечено достоверной корелляции между видом вмешательства и частотой интраоперационных осложнений, которые развивались в 14,3; 11,1 и 4,7 % соответственно в группах ОЦЭ, ВАЦЭ и ЛЦЭ. Частота тяжелых осложнений (3 и более степени по Clavien) не различалась во всех группах, однако частота осложнений I–II степени была в 4 раза выше в группе ОЦЭ по сравнению с ЛЦЭ (19 и 4,7 %). Общий койко-день был ниже после лапароскопических операций (27,8; 32,6 и 22,6 дня после ОЦЭ, ВАЦЭ и ЛЦЭ), однако длительность нахождения в отделении реанимации достоверно не различалась и колебалась от 2,1 при ЛЦЭ до 5,1 дня при ОЦЭ. Зарегистрировано по 1 случаю периоперационной летальности в каждой группе, в целом показатель составил 5,8 %. Гемотрансфузия потребовалась у 19,6 % больных, и частота ее проведения была выше при ОЦЭ (33,3 %) по сравнению с ЛЦЭ (4,7 %). Средний объем интраоперационной кровопотери был ниже при ЛЦЭ (285 мл) по сравнению с ВАЦЭ (468 мл) и ОЦЭ (577 мл). Частота осложнений составила 19 (37,2 %) случаев в первые 30 дней после операции и 29 (56,8 %) в 90-дневный период. Наибольшие различия в группах отмечены в частоте гастроинтестинальных осложнений (прежде всего это касалось динамической кишечной непроходимости) со значительно меньшим процентом после ЛЦЭ (14,2 %) по сравнению с ОЦЭ (47,6 %) и ВАЦЭ (55 %).

Выводы. По полученным данным сделано заключение: ЛЦЭ является безопасным радикальным методом лечения РМП, ассоциированным с меньшей кровопотерей, меньшей частотой ранних послеоперационных осложнений (в том числе динамической кишечной непроходимости), приводящим к уменьшению сроков госпитализации.

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