Marquina-Sánchez M, Esquivel-Pedraza P, López-Velarde VG

Language: Spanish
References: 16
Page: 345-351
PDF size: 956.08 Kb.

ABSTRACT

Radical cystectomy or anterior pelvic exenteration with pelvic lymphadenectomy is the ideal treatment for invasive bladder cancer and in some cases, high-grade noninvasive bladder cancer. It is an aggressive procedure with significant morbidity and mortality that varies from 25-30% in the early postoperative period, and therefore efforts have been made to improve these figures. Laparoscopic surgery reduces blood loss and postoperative intestinal paresis. It results in shorter hospital stay, reduced postoperative pain, and does not alter oncological results.
Objective: To present a complex case of bladder and ureteral (residual) cancer.
Methods: Patient is a fifty-two-year-old woman who was admitted to the hospital with gross hematuria in December 2008. Ultrasound study revealed tumor in left kidney for which open left nephrectomy with anterior approach was performed by an oncological surgeon. Histopathological study of kidney revealed transitional cell carcinoma. Intermittent hematuria persisted and patient was managed with antibiotics. She was referred to the present authors in August 2009. Abdominal computed tomography scan reported tumor in the bladder. In August 2010, anterior pelvic exenteration, left ureterectomy (residual), urethrectomy, and bilateral lymphadenectomy were performed, along with Indiana Pouch construction.
Results: Patient was hospitalized for three days, surgery duration was seven hours, and blood loss was an approximate 800mL. Histopathological study reported grade 3 invasive transitional cell carcinoma of the bladder and ureter. Thirty-eight lymph nodes were negative for malignancy.
Conclusions: There are many reports in the international literature on radical cystectomy in both sexes for invasive transitional cell carcinoma of the bladder carried out with open, laparoscopic, and robot-assisted techniques. However, in Mexico, conventional (open) surgery still predominates, and the present case is one of the first to be performed using laparoscopy.

REFERENCES

1. Sotelo NR, Castillo O, Santinelli F, Mirandolino BM. Trucos y secretos. Cirugía Laparoscópica en Urología, Ed. la Galaxia. SLCLU y CAU. 2006;pp.145.

2. Parra RO, Andrus CH, Jones JP, Boullier JA. Laparoscopic cystectomy: initial report on a new treatment for the retained bladder. J Urol 1992;148:1140-4.

3. Gill IS, Fergany A, Klein EA, et al. Laparoscopic radical cystoprostatectomy with ileal conduit performed completely intracorporeally: the initial 2 cases. Urology 2000;56:26-9.

4. Gill IS, Kaouk JH, Meraney AM, et al. Laparoscopic radical cystectomy and continent orthotopic ileal neobladder performed completely intracorporeally: the initial experience. J Urol 2002;168:13-8.

5. Türk I, Deger S, Winkelmann B, et al. Complete laparoscopic approach for radical cystectomy and continent urinary diversion (sigma rectum pouch). Tech Urol 2001;7:2-6.

6. Menon M, Hemal AK, Tewari A, et al. Nerve-sparing robot-assisted radical cystoprostatectomy and urinary diversion. BJU Int 2003;92:232-6.

7. Denewer A, Kotb S, Hussein O, El-Maadawy M. Laparoscopic assisted cystectomy and lymphadenectomy for bladder cancer: initial experience. World J Surg 1999;23:608-11.

8. Finelli A, Gill IS, Desai MM, et al. Laparoscopic extended pelvic lymphadenectomy for bladder cancer: technique and initial outcomes. J Urol 2004;172(5Pt1):1809-12.

9. Türk I, Deger S, Winkelmann B, et al. Laroscopic radical cystectomy with continent urinary diversion (rectal sigmoid pouch) performed completely intracorporeally: the initial 5 cases. J Urol 2001;165(6Pt1):1863-6.

10. Peterson AC, Lance RS, Ahuja S. Laparoscopic hand assisted radical cystectomy with ileal conduit urinary diversion. J Urol. 2002 Nov;168(5):2103-5.

11. Simonato A, Gregori A, Lissiani A, et al. Laparoscopic radical cystoprostatectomy: a technique illustrated step by step. Eur Urol 2003;44:132-8.

12. Moinzadeh A, Gill IS, Desai M, et al. Laparoscopic Radical Cystectomy en the female. J Urol 2005;173:1912-7.

13. Koh CH. A new technique and system for simplifying total laparoscopic hysterectomy. J Am Assoc Gynecol Laparosc 1998;5:187-92.

14. Stein JP, Lieskovsky G, Cote R, et al. Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol 2001;19:666-75.

15. Moinzadeh A, Gill IS. Laparoscopic radical cystectomy with urinary diversion. Curr Opin Urol 2004;14:83-7.

16. Guillotreau J, Gamé X, Mouzin M, et al. Radical cystectomy for bladder cáncer: morbidity of laparoscopic versus open surgery. J Urol 2009;181:554-9.