Shamrayeva D.M. Improvement of radical surgical treatment of patients with muscle-invasive bladder cancer and prediction of its early results. – Qualifying scientific work on manuscript rights.
Dissertation for obtaining the scientific degree of doctor of philosophy on the specialty 14.01.06 - Urology. - State University "Institute of Urology named after Acad. O.F. Vozianov of the National Academy of Medical Sciences of Ukraine", Kyiv, 2024.
The defense will take place in the specialized academic council D 26.615.001 at the State University "Institute of Urology named after Acad. O.F. Vozianov of the National Academy of Medical Sciences of Ukraine", Kyiv, 2024.
The aim of the dissertation was to improve the results of treatment of patients with muscle-invasive bladder cancer by developing and implementing an improved method of forming an ileal orthotopic bladder after radical cystectomy and developing criteria for predicting favorable and unfavorable outcomes and perioperative complications of patients with MIRSM. The study included a retrospective analysis of the results of RCE with different types of urine derivation for the period 2012–2021, as well as a prospective analysis of the new technology of artificial bladder formation. 9 observation groups were formed, which included patients who underwent RCE with different types of urinary diversion, including: ureterocutaneous neostomy (n=92), Bricker urine diversion (n=50), heterotopic Indiana diversion (n=12), orthotopic ileoneocystoplasty according to Studer (n=42) and others.A prospective study included patients who underwent RCE with a new modified technique (n=18).
The analysis showed that the majority of patients lived in industrial regions, where the influence of environmental factors was significant. During the period 2015–2019, there was a decrease (by 28–35.7%) in the frequency of performing urinary diversions with the use of stomas in comparison with orthotopic ilium cystoplasty (by 28%). During the COVID-19 pandemic, this trend changed due to late patient referrals.Among 86 clinical parameters, 34 (39.53%) were statistically significant, including patient age, disease history, tumor volume, disease stage, duration of surgery, and blood loss. It turned out that RCE with various types of urine derivation in 72-85% of cases led to "minor" complications (Clavien-Dindo I-II degree) and in 10-25% - to "major" complications (III-V degree) .Patients who underwent RCE with a modified method of ileal orthotopic bladder formation had statistically significantly less blood loss by 61.67% (207.05±22.89 ml vs. 540.47±52.88 ml in Studer's group, p<0.001) , a lower frequency of blood transfusions (p<0.001) and a higher level of postoperative hemoglobin (115 g/l vs. 99.5 g/l, p<0.01).The time of bladder catheterization decreased by 42% (10.11±0.76 days vs. 17.35±1.04 days, p<0.001), and the duration of hospitalization by 50% (13.29±1.04 days vs. 26 .23±1.13 days, p<0.001).The proposed technique also made it possible to reduce the operation time by 20.25% (p<0.001) and anesthesia by 17.12% (p<0.001), which reduced the financial costs of anesthesia. The modification did not increase the risk of genitourinary or infectious complications, but increased the frequency of "minor" complications due to lymphorrhea (p=0.049).In general, the proposed method allows to improve the results of MIRSM treatment, reduce the number of complications and increase the comfort of patients after surgery.
