Comparative Characteristics of the Direct Results of Extraperitoneal and Transperitoneal Access in the Surgical Treatment of Bladder Cancer

Abstract

Objective: To compare the results of transperitoneal and extraperitoneal access during radical cystectomy for muscle-invasive bladder cancer to choose the most rational method of surgical treatment.

Materials and methods:The study included 141 patients with muscle-invasive bladder cancer in the T2-3N0-2M0 stage from January 2014 to December 2017. Patients were alternatively divided into groups with transperitoneal access (TPD) n=62, and extraperitoneal access (EPD) n=79.

Results: The average operation time for EPD with ureterocutaneostomy was 142.1 min (range 90-192 min) and for TPD 127.5 min (range 75-180 min), p < 0.05, which is not statistically significant, that is the average operation time between the groups showed no differences. The mean estimated blood loss (EPD) was 375 ml (range 210-2800 ml) and 320 ml (range 180-3100 ml) for the DP group (p = 0.43). The average hospitalization was 7 (6-14 ) days for EPD and 12 (9-24) days for PD groups, (p = 0.48 with the Mann-Whitney ratio).Postoperative complications were divided into 2 groups: surgical and non-surgical. In total, surgical complications were observed in 36 patients (25.5%), of which 23 (37.1%) were patients with TP, and 13 (16.4%) cases in the group with EPD. Non-surgical complications were observed in 31(22%) patients, and there was no significant difference between the groups. Pyelonephritis was mainly observed in 21 (14.9%) patients, cardiovascular pathology in 3 (2.1%) patients, and pulmonary embolism (PE) was observed in 7 (4.9%) of the total number of patients studied. Depending on the severity of postoperative complications, we performed the analysis on the Clavien-Dindo scale, according to which in the general study group, postoperative surgical complications developed in 36 of 141 patients, which was 41.8%. At the same time, in the TPD group – 23 37.1%), in the group with EPD-13 (16.4%), p<0.05Intestinal obstruction developed in 3 and 14 patients in the EPD and TPD groups, respectively (p = 0.002); of these, only 4 of the TPD group required repeated surgery. Pelvic lymphocele (>100 ml) was observed in 5 and 1 patients in the TPD and EPD groups, respectively (p = 0.13).

Conclusion Extraperitoneal technique (EPD) with extraperitonealization of the neoplasm is a safe and reliable surgical approach. It has tetrafunctual advantages from the point of view of reduction of intestinal obstruction, frequency of repeated operations, the problems with the stripes and adhesive disease. The extraperitoneal technique with radical cystectomy is comparable in safety and reliability to the transperitoneal surgical approach and gives good peri-and postoperative results according to the parameters studied by us. A significant reduction in postoperative intestinal obstruction and adhesive disease is noteworthy. Thus, EPD is safe both functionally and oncologically.