The Early Outcomes of Extraperitoneal Radical Cystectomy / 대한비뇨기과학회지

ABSTRACT

PURPOSE: Radical cystectomy with pelvic lymphadenectomy is an effective therapeutic modality in invasive bladder cancer. The development of another technique for a radical cystectomy for the early recovery and reduction of complications was attempted. MATERIALS AND METHODS: Between March 1997 and June 2003, an extraperitoneal radical cystectomy was attempted in 18 patients with invasive bladder cancer (pT1-pT4). Not only standard or extended pelvic lymphadenectomy, but also re-positioning of the ureter to the opposite side, could be performed extraperitoneally. An intestinal segment could be taken out through a small window within the peritoneum and manipulated as desired. The clinical safety and complications of other surgical approaches for radical cystectomy were also investigated. RESULTS: The procedure was successful in 15 of the 18 patients (4 studer pouches, 3 ileal conduits and 8 ureterocutaneostomies). Failure to peel out the peritoneum occurred in 3 cases, 1 each due to technical difficulties, tumor invasion at the bladder dome and adhesion due to a previous radical prostatectomy. Complications occurred in 8 cases (53.1%). The intestinal obstruction progressed in 1 case (12.5%) due to a high positioned mesentery of the Studer pouch. There were no significant gastrointestinal complications in any of the 8 patients that underwent the extraperitoneal radical cystectomy with ureterocutaneostomy. CONCLUSIONS: An extraperitoneal radical cystectomy seems to reduce the gastrointestinal complications and be worthwhile in certain cases with advanced bladder cancer. Despite the visual limitation, it is an acceptable surgical technique compared to the conventional transperitoneal methods.