Modified Ileal Conduit for Urinary Diversion After Radical Cystectomy: Perioperative and Oncological Outcomes

Abstract

Background: To evaluate the surgical effects and oncological outcomes of modified ileal conduit (IC) after radical cystectomy (RC) for bladder cancer.Methods: A single-centre cohort of 211 consecutive bladder cancer patients who underwent RC + modified IC from September 2012 to August 2019 were retrospectively studied. Demographic data, perioperative results, complications 30 and 90 days after surgery and oncological outcomes were recorded. Kaplan–Meier method was used to plot the stage-specific survival results. The 5-year recurrence-free survival (RFS）and overall survival (OS) rate was calculated. Univariate and multivariate Cox regression analyses assessed the predictive risk factors on survival rate.Results: Overall, 211 patients received modified IC after RC. The median operative time (OT) was 315 minutes (IQR, 260–375 minutes), and the median estimated blood loss (EBL) was 500 ml (IQR, 300–900 ml). There were a total of 103 (48.8%) complications. There were 35, 54, 11, and 2 cases of grade I, II, III, and IV complications, respectively; of which 89 cases were grade I and II, accounting for 87.3% of total cases. There were 38 cases of preoperative hydronephrosis and 22 cases of postoperative hydronephrosis. There were 19, 24, 108, 40, and 20 cases of PT0, T1, T2, T3, and T4, respectively, in postoperative pathological stages. The median lymphadenectomy was 14 (IQR, 6–18), and lymph node was found positive in 18 patients. The median follow-up time was 26 months (IQR, 13–43), with a total survival of 177 (83.9%), an RFS of 171 (81%), and 34 deaths. The estimated 5-year OS and RFS rates were 76.80% and 79.10%. Preoperative comorbidities, pathological stage, grade, and lymph node involvement were important influencing factors for OS, while preoperative comorbidities and high pathological grade were important influencing factors for RFS.Conclusions: Modified IC after RC not only can achieve lower postoperative complications, especially the lower incidence of uretero-ileal anastomosis and stoma-related complications but can also achieve the established oncological outcomes of critical radical surgery.