, Dong Hyeon Lee, Kwang Hyun Kim, Dong-Ryeol Ryu, Seung-Jung Kim, Duk-Hee Kang, Kyu Bok Choi, Shina Lee Metabolic acidosis frequently develops in patients after neobladder reconstruction. However, the incidence of metabolic acidosis in patients with neobladder and the factors associated with the development of metabolic acidosis have not been well elucidated. We aimed to investigate the incidence and the potential predictors for the development of metabolic acidosis after neobladder reconstruction with intestinal segment.
We included patients who underwent neobladder reconstruction using intestinal segment at Ewha Womans University Mokdong Hospital between January 1, 2005 and December 31, 2014. A subgroup of patients according to the time of metabolic acidosis occurrence was further analyzed in order to characterize predictors for metabolic acidosis.
Metabolic acidosis was encountered in 79.4% of patients with neobladder during follow up period. When patients were divided into 2 groups according to anion gap (AG), total CO2 (18.9±2.1 mEq/L vs. 20.0±1.3 mEq/L, P=0.001) and chloride (106.6±4.9 mE/L vs. 109.4±3.6 mEq/L, P<0.001) were significant different between groups with AG>12 and AG≤12. Furthermore, when patients were divided into 3 groups; patients with metabolic acidosis at postoperative day (POD) 1; from POD 2 to 14 days; after 14 days, there was significant difference among those subgroups.
Our study showed the rate of metabolic acidosis in patients underwent neobladder reconstruction and the difference between patients with metabolic acidosis and those without metabolic acidosis for the first time in Korea. In the future, well designed prospective study will be needed to prevent metabolic acidosis after neobladder reconstruction.
, Dong Hyeon Lee Robot-assisted laparoscopic radical cystectomy (RARC) for the treatment of muscle invasive bladder cancer is being increasingly applied. Radical cystectomy is complex procedure which should be performed with extensive lymph node dissection and urinary diversion. Currently, the techniques of RARC are well-described, and the feasibility and safety of RARC has been demonstrated. While extracorporeal approach is preferred method for urinary diversion, intracorporeal urinary diversion is gaining popularity. Positive surgical margins are similar to large open series but inferior for locally advanced disease. However, local recurrence and survival rates seem equivalent to open series at short and mid-term follow up. Randomized controlled trial should be conducted to rigorously assess the oncologic outcomes of RARC compared to open radical cystectomy.
, Young Yo Park Bladder cancer is the second most common malignancy in urological field. Most new cases are diagnosed as non-muscle invasive bladder cancer (NMIBC), which includes Ta, T1 or carcinoma in situ. Initial management of NMIBC is endoscopic resection, which allows both treatment and pathological staging. Urologist should consider adjuvant intravesical chemotherapy or Bacillus Calmette-Guerin (BCG) immunotherapy, depending on the tumor grade or stage to prevent recurrence and progression. Patients with muscle invasive bladder cancer (MIBC) are best treated with radical cystectomy. However, radical cystectomy should be considered even in patients with NMIBC with high risk of progression and BCG refractory tumors. Delay of radical cystectomy in these patients might lead decreased disease specific survival. Patients treated by radical cystectomy should undergo any form of the urinary diversion. Ileal conduit is still most common method for urinary diversion. Orthotopic neobladder is generally performed by experienced hands in high volume center. Patients undergoing orthotopic neobladder should be educated and manually skillful to manipulate their diversion. Neoadjuvant cisplatin-based chemotherapy is recommended based on level 1 evidence with survival benefit. Recent updated meta-analysis also demonstrated survival benefit in patients with MIBC treated by adjuvant chemotherapy.
Citations
, Sun Young Yi, Kyung Eun Lee Unexpected carcinoma of gallbaldder(GB) can be found in 1-2% of specimens after surgery of benign biliary disease. This study was designed to investigate the clinicopathological and radiological characteristics of unexpected GB cancer presumed benign biliary disease and compare with originally diagnosed GB cancer.
The modical records of nineteen patients(5 males and 14 females, mean age : 64±9 years) with unexpected GB cancer diagnosed postoperatively(Group 1 : cholecystitis, 12 cases ; GB empyema, 4 cases ; cholecystitis with bile duct stone, 3 cases) and thirty seven patients (12males and 25 females, mean age : 68±11 years) with originally diagnosed GB cancer(Group 2) were retrospectively reviewed at Ewha Womans university Mokdong hospital from October, 1993 to March, 1999.
Clinical findings including right upper quadrant pain, fever, and chilling were pre-dominant in group 1 and general weakness, anorexia, and weight loss were predominant in group 2. Ultrasonographic findings of the group 1 were not typical to detect GB cacer Diffuse thickened GB wall showed 47.3% and the gallstone showed 89.5% in group 1. The mass of thickened GB wall irregularly revealed in all and gallstone showed in 50% of group 2. The TMN stage of goup 1 revealed earlier stage than group 2. The curative resection was performed in 84.2% and 10% in group 1 and 2, respectively.
The stage of unexpected GB cancer revealed relatively early stage and the curative resection rate was higher than originally diagnosed GB cancer. Therefore, the careful and detail intraoperative histologic examination of considered in patient with clinical features of benign biliary disease to detect early and improve prognosis in the patients of GB cancer.
First
Prev
