Background. Bladder cancer is a serious problem of modern oncourology due to the annual increase in the number of diagnosed malignant neoplasms of the urinary system. High-risk muscle-invasive and non-muscle-invasive forms are subject to surgical treatment, while open radical cystectomy serves as the “gold standard”. Laparoscopic and robot-assisted radical cystectomy are serious competitors to this method. To date, the robotic method of removing the bladder is the least studied, despite the fact that it seems to be the most technologically advanced and modern.Aim. To analyze the own results of the use of robot-assisted interventions in high-risk musculoskeletal and non-musculoskeletal invasive bladder cancer, as well as to study the literature on the use of robot-assisted radical cystectomy in the treatment of malignant neoplasms of the bladder.Materials and methods. A prospective study was conducted on the basis of the clinic of the Bashkir State Medical University with the participation of 70 patients who were diagnosed with bladder cancer (T1–T4). The subjects underwent a robot-assisted radical cystectomy with various variants of urine derivation.Results. At the end of the study, the outcomes after robot-assisted radical cystectomy were analyzed and evaluated. The primary endpoints were 30- and 90-day complications of the Clavien–Dindo system. According to secondary indicators, robot-assisted radical cystectomy demonstrated a low duration of surgery, intraoperative blood loss.Conclusion. Robot-assisted radical cystectomy is a serious competitor to open and laparoscopic interventions for early and long-term perioperative indicators. This technique has shown its profitability in the treatment of bladder cancer, demonstrating a sufficient level of effectiveness and safety.
Introduction. Radical cystectomy with urine diversion is recognized as the standard for the treatment of muscle-invasive bladder cancer. One of the dangerous complications in the postoperative period is the stricture of uretero-ileal anastomosis leading to hydroureteronephrosis, renal failure, and urosepsis. One of the factors in the development of the anastomotic stricture is ischemia. In order to reduce possible ischemic injury, the following manipulations are performed: careful treatment of tissues in the area of future anastomosis, preservation of periureteral adventitia, minimal mobilization of ureters before implantation into conduit. Intraoperative assessment of ureteral and intestinal tissue perfusion using ICG-fluorescence is a promising area. Materials and methods. The study enrolled 56 patients who underwent a robotic-assisted radical cystectomy with intracorporeal urine diversion from January 2021 to March 2022 at the Bashkir State Medical University Clinic. Patients were divided into two groups: group 1 (22 patients) underwent intraoperative ICG-imaging, and group 2 (34 patients) — imaging without fluorescence. The median follow-up period was 14 months for group 1 and 12 months for group 2. The comparison criteria between the groups were demographic indicators, perioperative outcomes (including 30- and 90-day complications), and the incidence of strictures of uretero-ileal anastomoses. The groups were compared using a test for equality of means and a test for sampling distributions. Results and discussion. No statistically significant differences between patients were reported during the time of surgery, estimated blood loss, and duration of hospital stay. No significant differences were also detected in the incidence of 30- and 90-day complications and the number of readmissions among patients in group 1 and group 2 (p = 0.477 and p = 0.089, respectively). The incidence of strictures of uretero-ileal anastomosis in group 1 demonstrated a statistically significant decrease, as compared with group 2 (0/34 [0 %] and 7/68 [10.3 %], p = 0.020). Conclusion. The ICG-fluorescence imaging to assess vascularization of the distal ureter during robotic-assisted radical cystectomy with intracorporeal urine diversion may reduce the risk of postoperative uretero-ileal anastomotic ischemic strictures.
Radical cystectomy is the gold standard treatment for aggressive bladder cancer. Pelvic lymphadenectomy is an important step. This procedure is crucial for the cancer staging, determination of further treatment strategy, and optimization of surgical outcomes. Currently, the sentinel lymph node concept is being actively developed, which allows to reduce the required extent of pelvic lymph node dissection. Decrease in number of removed pelvic lymph node improves surgical safety of the patient. Indocyanine green near-infrared fluorescence is the main approach to the intraoperative visualization of sentinel lymph nodes. The prospects of this diagnostic technique application in radical cystectomy performed for bladder cancer determine the vector of future scientific research in this area.
The review summarizes current information about the role and significance of adhesion molecules in the process of tumor metastasis. For example, different tumors is shown that changes in the expression of adhesion molecules leads to disruption of the regulatory interactions in the processes of proliferation, cytodifferentiation and migration of tumor cells, enables the cascade of pathological processes leading to the colonization of other tumor cells remote from the tumor bodies. The phenomenology of tumor development and metastasis is shown. The participation of the main groups of adhesion molecules (cadherins, integrins, selectins, immunoglobulins and white blood cell homing receptors) at the stages of metastasis is considered. A violation of cadherin expression is accompanied by a decrease in the expression of integrins involved in the formation of hemidesmosomes, while a cascade of reactions develops that contributes to the development of an aggressive malignant phenotype, cells acquire an increased ability to migrate and invade, resulting in the appearance of a tumor in secondary foci. The role of immunoglobulins in the development of metastatic process has been studied in less detail than in cadherins and integrins. It was found that immunoglobulins are involved in the formation of resistance of tumor cells to proapoptotic signals. Immunoglobulins increase the expression of metalloproteinase genes involved in the degradation of the extracellular matrix, which is a factor in the initiation of metastasis. A correlation between increased selectin expression and increased metastasis is shown. An increase in the expression level of white blood cell homing receptors leads to an increase in the invasive potential of tumors. The results of the study of cell adhesion proteins serve as a fundamental basis for the development of methods of antitumor therapy. Over the past decades, a number of immunohistochemical protein detection reactions have become one of the diagnostic methods of cancer clinics. However, the role of cell adhesion molecules in ensuring the metastasis process, as well as their significance in the prognosis of the development of the tumor process and antitumor therapy, needs to be further studied.
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