OBJECTIVE: Radical bladder cancer surgery is difficult, with many perioperative complications and a long learning curve. This study introduces a new systematic surgical approach of total retrograde radical cystectomy with abdominal reconstruction, and discusses its clinical value.
METHODS: From April 2012 to April 2013, a total of 110 male bladder cancer patients with a median age of 64 years (35-83 years) underwent this systematic surgical treatment in our department; preoperative clinical data were compiled and analyzed for surgery-related parameters, complications, pathological features, long-term complications, and recurrent metastases.
RESULTS: The number of lymph nodes cleared intraoperatively was 12 (8-16); bilateral neurovascular bundles were preserved in 65 cases and unilateral in 31 cases; the operation took 4.4 hours (2.2-6.0 hours), median abdominal organ exposure time was 43 minutes (5-75 minutes), median bleeding volume was 140 ml (50-600 ml), and 4 patients had blood transfusion; median pelvic-abdominal drainage time was 10.0 days ( 6-15 days), median postoperative ventilation time 2.5 days (1-12 days), median postoperative hospitalization time 17.0 days (10-39 days); 19 cases with postoperative complications CDC grade 2, i.e., requiring pharmacological intervention, and 8 cases with CDC grade 3 or higher; 5 cases with mild to moderate postoperative intestinal obstruction, treated with symptomatic support and resumed feeding after a median of 2 weeks (1-4 weeks); no perioperative death There were no perioperative deaths. The pathology was clear, with a median follow-up of 9 months (3-15 months), no complications of CDC grade 3 or above, and no recurrent metastases.
CONCLUSION: With a clear anatomical approach of total retrograde radical cystectomy, reliable preservation of the vascular nerve bundle, low intraoperative bleeding, short exposure time of the entire abdominal organs, less mutual interference between the intestine and the operative field, more peritoneal preservation on the basis of ensuring the principle of tumor-free, which is conducive to subsequent operations, combined with abdominal reconstruction, this systematic surgery effectively accelerates the recovery of the patient’s intestine, reduces postoperative complications, especially the occurrence of intestinal obstruction and severity, shorten the hospital stay, and have a short learning curve, which is worthy of further study and promotion.