Liu Z, Meng Y, Li S, Yu W, Jin J. Perioperative recovery in different urinary reconstruction approaches of radical cystectomy: Are the advantages of laparoscopy consistent?
J Minim Access Surg 2020;
16:390-398. [PMID:
31929226 PMCID:
PMC7597872 DOI:
10.4103/jmas.jmas_227_19]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 11/04/2019] [Accepted: 11/27/2019] [Indexed: 11/17/2022] Open
Abstract
CONTEXT
Radical cystectomy (RC) has complicated surgical procedures and various ways of urinary reconstruction.
AIMS
The aim of this study is to investigate whether the advantages of laparoscopy over open surgery were consistent in the perioperative recovery of different methods of urinary diversion after RC in the general and the elderly (>65 years) population.
SETTINGS AND DESIGN
A retrospective study reviewed 452 (elderly 261) patients who received RC from the year 2005-2012.
SUBJECTS AND METHODS
Of all, 88 patients underwent laparoscopic RC (LRC) and 364 patients underwent open RC (ORC). There were 325 patients received ileal conduit (IC), whereas 127 patients received cutaneous ureterostomy (CU).
STATISTICAL ANALYSIS USED
We used different statistical methods (t-test, Chi-square, etc.) to compare variables outcomes.
RESULTS
For IC urinary diversion, the general patients undergoing LRC had less intra-operative blood loss (566.5 vs. 1320.3 ml, P < 0.001), lower blood transfusion rate (11.4 vs. 34.1%, P < 0.001), shorter gastrointestinal recovery time (5.7 vs. 6.7 days, P= 0.002) and shorter length of hospital stay (LOS) (21.7 vs. 26.0 days, P = 0.003) than patients receiving ORC. Similar trends were observed in older patients. For CU urinary diversion, the general and the elderly patients receiving LRC had a shorter mean time to gastrointestinal recovery (P = 0.017, P < 0.001, respectively) than patients receiving ORC. No differences were found between LRC and ORC in intra-operative blood loss, allogeneic blood transfusion rate and LOS.
CONCLUSIONS
In the general and the elderly population, laparoscopic approach could result in more rapid rehabilitation for RC patients, especially in the IC patients.
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