Surgical techniques, oncologic and functional outcomes of two types of modified ileal orthotopic neobladders

In recent years, the construction of orthotopic neobladder has become the focus of research. Our study is aim to illustrate and evaluate surgical techniques, oncologic and functional outcomes of two types of modified ileal orthotopic neobladders (IONB).

We retrospectively reviewed of 64 patients who underwent laparoscopic radical cystectomy (LRC) + Xing's neobladder (n=41), Institute of Urology Peking University neobladder (IUPUB) (n=23) at two tertiary referral centers. Then demographic characteristics, operation outcomes were analyzed. In addition, postoperative complication rates, oncologic outcomes, continence, and neobladders' function were further evaluated.

All LRC + IONB were carried out in 64 patients successfully. Pathological results show that 63 were urothelial carcinoma and 1 was adenocarcinoma. Time to flatus was 3 [1-6] d in Xing's neobladder group while 3 [2-5] d in IUPUB group (P=0.049). In terms of overall survival (OS), cancer specific survival (CSS) and recurrence-free survival (RFS), there is no statistical difference between the two groups. Overall, grade 1-2 complications were 36%, grade 3-4 complications were 1.6% on the 30th day, and 15.6%, 1.6% respectively on the 90th day. On the whole, daytime and night continence were 96.4%, 83.6% respectively one year after operation.

The two types of modified IONB are safe and feasible. The technical improvements significantly simplify the procedure and decrease the difficulty of the surgery, probably shorten the operative time and reduce blood loss. Furthermore, they take the advantage of less late complications and comparative good functional outcomes without affecting the prognosis of oncology. In addition, Xing's neobladder is more beneficial to the recovery of postoperative gastrointestinal function.