Clinical efficacy of laparoscopic radical cystectomy with intracorporeal urinary diversion and an analysis of factors influencing complications

TL;DR

This study compares laparoscopic bladder cancer surgery with two urinary diversion methods and finds that intracorporeal diversion has benefits like less blood loss and faster recovery.

Contribution

Demonstrates the safety and advantages of intracorporeal urinary diversion in laparoscopic cystectomy for bladder cancer.

Findings

ICUD resulted in less intraoperative blood loss and earlier postoperative diet initiation compared to ECUD.

Smoking history, diabetes, and intraoperative blood loss were identified as risk factors for major complications.

ICUD showed fewer ≥III grade complications compared to ECUD, though the difference was not statistically significant.

Abstract

To explore the feasibility of combined laparoscopic radical cystectomy (LRC) and intracorporeal urinary diversion (ICUD) in the treatment of bladder cancer, as well as the influencing factors related to complications.

A retrospective study was conducted on 116 bladder cancer patients who underwent LRC at our facility between January 2019 and December 2023. Based on the different urinary diversion methods, 78 patients received extracorporeal urinary diversion (ECUD), while 38 patients underwent intracorporeal urinary diversion (ICUD). The two groups were compared in terms of clinicopathologic data, perioperative outcomes, postoperative tumor control, complication rates, and their influencing factors.

No statistically significant differences were observed between the two groups in terms of median total operative time, hospital stay, perioperative transfusion rate, and short-term oncological outcomes. Compared to the ECUD group, the ICUD group experienced less intraoperative blood loss (200 ml vs. 350 ml) and an earlier start to postoperative liquid diet intake (4 days vs. 5 days) (p < 0.05). A total of 24 cases of ≥III grade complications occurred within 90 days postoperatively, with 20 cases in the ECUD group and 4 in the ICUD group. There was no significant difference in the incidence of ≥III grade complications between the two groups (p > 0.05). Sepsis was the most common major complication. Logistic regression analysis identified smoking history, diabetes, and intraoperative blood loss as independent risk factors for ≥III complications.

ICUD is a secure and effective method with advantages such as improved postoperative bowel recovery, reduced intraoperative blood loss, and fewer overall postoperative complications. Furthermore, major complications are influenced by multiple risk factors and should be carefully considered during preoperative and postoperative management.

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