[Clinical outcomes for young patients with muscular invasive bladder cancer who received robot-assisted radical cystectomy].

Abstract

Objective: To evaluate the clinical features, surgical effects and factors that may affect prognosis of muscular invasive bladder cancer in young people. Methods: The clinical data of young (aged 44 and below) patients with muscle invasive bladder cancer who underwent robot-assisted radical cystectomy at the First Affiliated Hospital of Zhengzhou University from October 1st, 2014 to October 31st, 2018 were retrospectively analyzed, which included age, gender, body mass index (BMI), tumor discovery method, tumor location, tumor size, comorbid diseases, operation time, intraoperative blood loss, urinary diversion method, postoperative complications, postoperative hospital stay, postoperative pathology and follow-up results. Results: A total of 24 patients were enrolled in this study, and 18(75%) were male and 6(25%) were female. The age was (40.4±3.5) years and the BMI was (24.7±2.5) kg/m2. At initial visit, there were 19(79%) patients who presented with hematuria, 4 (17%) with lower urinary tract symptoms, and 1(4%) was discovered by routine examination. Fifteen (62%) patients had single tumor, and 9(38%) had multiple tumors. The tumor diameter of 14(58%) patients were ≥3 cm and 3(13%) patients were combined with hydronephrosis. All patients received robot-assisted radical cystectomy successfully. The operative time was (325.8±57.2) min, and the blood loss during operation was 200(162,300) ml. The duration of postoperative hospital stay was 11(9,22) days. And according to different urinary diversion methods, 17(80%) patients had ileal orthotopic neobladder and 7(20%) had ileal conduit. For patients whose sexual nerves were preserved, 6(6/9) recovered their sexual function after one year of the surgery. The final pathological results showed that 16(67%) patients were in T2 stage, 7(29%) patients were in T3 stage and that 1(4%) patient in T4 stage. There were 6 (25%) patients with lymphatic metastasis, 8(33%) with low-grade papillary urothelial carcinoma, 14(58%) with high-grade papillary urothelial carcinoma, 1(4%) with adenocarcinoma and 1(4%) with small cell neuroendocrine carcinoma. Early complications of the patients were mostly slight, and only 2(8%) patients had Clavien Ⅲdegree complications, while few patients had late complications. The follow-up time was (26±12) months. During the follow-up time, there was 1(4%) patient who died because of liver and kidney failure. Distant metastasis occurred in 4(17%) cases and 1(4%) patient had urothelial carcinoma on one side of the ureter. Lymphatic metastasis (P=0.018) and ≥ T3 (P=0.038) stage were associated with the prognosis. Conclusions: For young patients with muscular invasive bladder cancer, the major initial presentation is hematuria, and most of them have advanced tumor stage and high malignant degree. Robot-assisted radical cystectomy is a safe and effective operation method with less postoperative complications, and protecting sexual nerve contributes to the recovery of sexual function. Advanced tumor stage (≥T3) and lymphatic metastasis are associated with distant metastasis and recurrence.