Mesane Kanserinde Radikal Sistektomi Operasyonunun Önemi ve Takip Döneminde Karşılaşılan Komplikasyonlar: Tek Merkez Deneyimi

Yıl 2020, Cilt: 17 Sayı: 1, 33 - 36, 29.04.2020

Ergün Alma Adem Altunkol Hakan Erçil Güçlü Gürlen Nevzat Can Şener Zafer Gökhan Gürbüz

https://doi.org/10.35440/hutfd.640231

Öz

Amaç: Kliniğimizde yapılan radikal sistektomi operasyonlarının onkolojik ve fonksiyonel sonuçlarının değerlendirilmesi.
Materyal ve metod: Eylül 2016 ve Haziran 2019 tarihleri arasında gerçekleştirilen 42 sistektomi hastasının kayıtları retrospektif olarak incelendi. Demografikler, patolojik inceleme sonuçları, diversiyon yöntemleri, hospitalizasyon süreleri, ortalama takip süresi ve oluşan komplikasyonlar değerlendirildi.
Bulgular: Çalışmamız yaş ortalaması 65.1±8.8 yıl olan 4 kadın ve 38 erkek hasta olmak üzere toplam 42 hastadan oluşmaktaydı. Ortalama hastanede yatış süreleri 18.7±8.3 gün ve ortalama takip süresi 10.8±6.1 ay idi. 15 hasta(%35.7) sistektomi öncesi neoadjuvan kemoterapi almıştı. Sistektomi materyallerinin patolojik değerlendirmesinde 19 pT1 ve 19 pT2, 6 pT0, 2 pT4 evre saptandı. En sık yapılan diversiyon ileal loop idi. Takip periyodunda 26 (%61.9) hastada değişik derecelerde komplikasyon izlendi.
Sonuç: Radikal sistektomi operasyonu morbiditesi yüksek ve bazen mortal olabilen bir cerrahi olmasına rağmen onkolojik sonuçları ile beraber değerlendirildiğinde deneyimli merkezlerde başarı ile uygulanabilen bir cerrahi prosedürdür. 

Anahtar Kelimeler

Sistektomi, diversiyon, ileal loop

Importance of Radical Cystectomy Operation in Bladder Cancer and Complications Encountered During Follow-up: Single Center Experience

Öz

Background: To evaluate the oncological and functional results of radical cystectomy operations performed in our clinic.
Materials and Methods: The records of 42 cystectomy patients performed between September 2016 and June 2019 were reviewed retrospectively. Demographics, pathological examination results, diversion methods, hospitalization time, mean follow-up and complications were evaluated.
Results: Our study consisted of 42 patients (4 female and 38 male) with a mean age of 65.1 ± 8.8 years. The mean hospital stay was 18.7 ± 8.3 days and the mean follow-up was 10.8 ± 6.1 months. Fifteen patients (35.7%) had received neoadjuvant chemotherapy before cystectomy. Pathologic evaluation of cystectomy materials revealed 19 pT1 and 19 pT2, 6 pT0, 2 pT4 stages. The most common diversion was ileal loop. During the follow-up period, 26 (61.9%) patients had varying degrees of complication.
Conclusions: Radical cystectomy is a surgical procedure that can be performed successfully in experienced centers when evaluated with its oncologic results, although it is a highly morbid and sometimes mortal surgery.

Kaynakça

• 1- J.A. Witjes, M. Bruins, R. Cathomas, E. Compérat, N.C. Cowan, G. Gakis, et al. EAU Oncology Guidelines: Muscle-invasive and Metastatic Bladder Cancer.https://uroweb.org/ guideline/ Muscle-invasive and Metastatic Bladder Cancer 2019.2- Michel J, Goel AN, Golla V, Lenis AT, Johnson DC, Chamie K et al. Predicting Short-Term Outcomes After Radical Cystectomy Based on Frailty. Urology. 2019 Jul 12. pii: S0090-4295(19)30610-7. doi: 10.1016/j.urology.2019.04.057. 3- Altan M, Özdemir B, Çıtamak B, Akdoğan B, Özen H. Radikal Sistektomi Cerrahisinin Kalitesi Nasıl Ölçülebilir? Üroonkoloji Bülteni 2014;13:70-74.4- Hautmann RE, Abol-Enein H, Hafez K, Haro I, Mansson W, Mills RD et al. World Health Organization (WHO) Consensus Conference on Bladder Cancer. Urology. 2007 ;69(1):17-49.5- Rangarajan K, Somani BK. Trends in quality of life reporting for radical cystectomy and urinary diversion over the last four decades: A systematic review of the literature. Arab J Urol. 2019;17(3):181-194.6- Audenet F, Sfakianos JP. Evidence of Atypical Recurrences After Robot-Assisted Radical Cystectomy: A Comprehensive Review of the Literature. Bladder Cancer. 2017;3(4):231-6.7- Lobo N, Mount C, Omar K, Nair R, Thurairaja R, Khan MS. Landmarks in the treatment of muscle-invasive bladder cancer. Nat Rev Urol. 2017;14(9):565-574.8- Batur AF, Sözen S. Yüksek Riskli Kasa İnvaze Olmayan Mesane Kanserinde Erken Sistektomi mi yoksa Mesane Koruyucu Tedavi mi Tercih edelim? Üroonkoloji Bülteni 2014;13:93-8.9- Kulkarni GS, Hakenberg OW, Gschwend JE, Thalmann G, Kassouf W, Kamat A et al . An updated critical analysis of the treatment strategy for mewly diagnosed high-grade T1(previously T1G3) bladder cancer. Eur Urol 2010;57:60-70.10- Stein JP, Lieskovsky G, Cote R, Groshen S, Feng AC, Boyd S et al. Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol. 2001;19(3):666-75.11- Yin M, Joshi M, Meijer RP, Glantz M, Holder S, Harvey HA et al. Neoadjuvant Chemotherapy for Muscle-Invasive Bladder Cancer: A Systematic Review and Two-Step Meta-Analysis. Oncologist. 2016;21(6):708-15. 12- Griffiths G, Hall R, Sylvester R, Raghavan D, Parmar MK. International phase III trial assessing neoadjuvant cisplatin, methotrexate and vinblastine chemotherapy for muscle-invasive bladder cancer: long-term results of the BA06 30894 trial. J Clin Oncol. 2011;29(16):2171-7. 13- Lee RK, Abol-Enein H, Artibani W, Bochner B, Dalbagni G, Daneshmand S et al. Urinary diversion after radical cystectomy for bladder cancer: options, patient selection, and outcomes. BJU Int. 2014;113(1):11-23.14- Kiss B, Burkhard FC, Thalmann GN. Open radical cystectomy: still the gold standard for muscle invasive bladder cancer. World J Urol. 2016;34(1):33-9.15- McMullen CK, Kwan ML, Colwell JC, Munneke JR, Davis JV, Firemark A et al. Recovering from Cystectomy: Patient Perspectives. Bladder Cancer. 2019;5(1):51-61.16- Son SK, Lee NR, Kang SH, Lee SH. Safety and Effectiveness of Robot-Assisted Versus Open Radical Cystectomy for Bladder Cancer: A Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A. 2017;27(11):1109-20.17- Davis RB, Farber NJ, Tabakin AL, Kim IY, Elsamra SE. Open versus robotic cystectomy: Comparison of outcomes. Investig Clin Urol. 2016;57 (1):36-43.18- Bochner BH, Dalbagni G, Sjoberg DD, Silberstein J, Keren Paz GE, Donat SM et al. Comparing Open Radical Cystectomy and Robot assisted Laparoscopic Radical Cystectomy: A Randomized Clinical Trial. Eur Urol. 2015;67(6):1042-50.19- Bansal SS, Dogra T, Smith PW, Amran M, Auluck I, Bhambra M et al. Cost analysis of open radical cystectomy versus robot-assisted radical cystectomy. BJU Int. 2018;121(3):437-44.