World Journal of Laparoscopic Surgery

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VOLUME 9 , ISSUE 2 ( May-August, 2016 ) > List of Articles

RESEARCH ARTICLE

Comparison of Open and Laparoscopic Radical Cystectomy for Bladder Cancer: Safety and Early Oncological Results

Reva Sergey, Nosov Alexander, Djalilov Imran, Petrov Sergey

Citation Information : Sergey R, Alexander N, Imran D, Sergey P. Comparison of Open and Laparoscopic Radical Cystectomy for Bladder Cancer: Safety and Early Oncological Results. World J Lap Surg 2016; 9 (2):51-57.

DOI: 10.5005/jp-journals-10033-1272

Published Online: 01-08-2016

Copyright Statement:  Copyright © 2016; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Objectives

To evaluate perioperative and postoperative morbidity and functional results of laparoscopic radical cystectomy (LRC) in a single-site cohort of patients by comparing it with standard open radical cystectomy (ORC).

Materials and methods

A prospective analysis was performed in 42 muscle invasive and locally advanced bladder cancer (BCa) patients who underwent radical cystectomy (RC) between February 2012 and March 2014 in N.N. Petrov Research Institute of Oncology, Saint Petersburg, Russia. The final cohort included 21 ORC and 21 LRC patients. The average patients’ age was 64 (38 to 81) years, which did not differ between the groups. The pathological stage was similar in the LRC and ORC groups. Multivariable logistic and median regression was performed to evaluate the operating time, perioperative, and postoperative complications (30-day and 90-day) according to Clavien classification, readmission rates, and length of stay (LOS) – both totally and in ICU.

Results

The operating time during LRC was longer than that of ORC (398 vs 243 minutes respectively). Despite that, there was no statistically significant influence of the type of surgery on intraoperative complications. 14.3% in the ORC group and 4.7% in the LRC patients. The major complication rates (Clavien grade. ≥3; 23.8 vs 19.4%) were similar between the groups. However, LRC had four times lower rate of minor complications (Clavien grade 1 and 2) compared to ORC (4.7 vs 19.0%). Laparoscopic radical cystectomy had a significantly shorter LOS (27.8 vs 22.6 days in the ORC and LRC groups respectively), but no significant differences in ICU stay existed (5.1 vs 2.1 days). Morbidity was presented by one patient in each group (average rate 5.8%). The common transfusion rate during and after surgical intervention was 19.6% and was higher in the ORC group (33.3 vs 4.7% in LRC); additionally, intraoperative bleeding was lower after laparoscopic cystectomy. the average volume of blood loss was 285 mL in LRC and 577 mL during ORC. Depending on the timing of complications, there were 30-day complications in 19 patients (37.2%) and 90 days in 27 patients (52.9%). The greatest difference was observed between the grades of gastrointestinal complications (foremost, ileus) with significantly better outcomes in the LRC patients. 14.2% compared to 47.6% in ORC.

Conclusion

We have found that LRC is safe and associated with lower blood loss, reduced postoperative ileus, and lower LOS compared with ORC. Using a population-based cohort, we have found that laparoscopic surgery for bladder cancer reduced minor complications (mainly due to lower bleeding and gastrointestinal complication rate) and had no impact on major complications.

How to cite this article

Sergey R, Alexander N, Imran D, Sergey P. Comparison of Open and Laparoscopic Radical Cystectomy for Bladder Cancer: Safety and Early Oncological Results. World J Lap Surg 2016;9(2):51-57.


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  1. Identifying risk factors for potentially avoidable complications following radical cystectomy. J Urol 2005 Oct;174(4 Pt 1):1231-1237.
  2. Prevention and management of complications following radical cystectomy for bladder cancer. Eur Urol 2010 Jun;57(6):983-1001.
  3. The role of laparoscopic cystectomy in the management of muscleinvasive bladder cancer with special emphasis on cancer control and complications. Eur Urol 2011 Oct;60(4):767-775.
  4. ICUD-EAU International Consultation on Bladder Cancer 2012: urinary diversion. Eur Urol 2013 Jan;63(1):67-80.
  5. Nerve-sparing robot-assisted radical cystprostatectomy and urinary diversion. BJU Int 2003 Aug;92(3):232-236.
  6. Editorial comment on: defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol 2009 Jan;55(1):175-176.
  7. Multiinstitutional analysis of robotic radical cystectomy for bladder cancer: perioperative outcomes and complications in 227 patients. J Laparoendosc Adv Surg Tech A 2012 Jan-Feb;22(1):17-21.
  8. Enhanced recovery after surgery in patients undergoing radical cystectomy for bladder cancer. J Urol 2014 Jul;192(1):50-56.
  9. EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines. Eur Urol 2014 Apr;65(4):778-792.
  10. Technique of radical cystectomy. Urol Clin North Am 1981 Jun;8(2):353-366.
  11. Laparoscopic radical cystoprostatectomy: a technique illustrated step by step. Eur Urol 2003 Jul;44(1):132-138.
  12. Classification of surgical complications. A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004 Aug;240(2):205-213.
  13. Analysis of early complications after radical cystectomy: results of a collaborative care pathway. J Urol 2002 May;167(5):2012-2016.
  14. A critical analysis of perioperative mortality from radical cystectomy. J Urol 2006 Mar;175(3 Pt 1):886-889;discussion 889-890.
  15. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol 2009 Jan;55(1):164-174.
  16. Complications and mortality after radical cystectomy for bladder transitional cell cancer. J Urol 2009 Sep;182(3):914-921
  17. Standards for surgical complication reporting in urologic oncology: time for a change. Urology 2007 Feb;69(2):221-225.
  18. Early and late perioperative outcomes following radical cystectomy: 90-day readmissions, morbidity and mortality in a contemporary series. J Urol 2010 Oct;184(4):1296-1300.
  19. Comparing robotic, laparoscopic and open cystectomy: a systematic review and meta-analysis. Arch Ital Urol Androl 2015 Mar;31;87(1):41-48.
  20. The first 100 consecutive, robot-assisted, intracorporeal ileal conduits: evolution of technique and 90-day outcomes. Eur Urol 2013 Apr;63(4):637-643.
  21. Long-term outcome of ileal conduit. J Urol 2003 Mar;169(3):985-990.
  22. Noninfectious serious hazards of transfusion. Anesth Analg 2009 Mar;108(3):759-769.
  23. A comparison of postoperative complications in open versus robotic cystectomy. Eur Urol 2010 Feb;57(2):274-281.
  24. Laparoscopic radical cystectomy with orthotopic ileal neobladder for bladder cancer: oncologic result of 171 cases with a median 3-year follow-up. Eur Urol 2010 Sep;58(3):442-449.
  25. Robotic versus open radical cystectomy: identification of patients who benefit from the robotic approach. J Endourol 2013 Jan;27(1):40-44.
  26. Early and late complications of robot-assisted radical cystectomy: a standardized analysis by urinary diversion type. J Urol 2014 Mar;191(3):681-687.
  27. Complications in laparoscopic radical cystectomy. The South American experience with 59 cases. Int Braz J Urol 2006 May-Jun;32(3):300-305.
  28. Definition, incidence, risk factors and prevention of paralytic ileus following radical cystectomy: a systematic review. Eur Urol 2013 Oct;64(4):588-597.
  29. Long-term evaluation of oncologic and functional outcomes after laparoscopic open-assisted radical cystectomy: a match-pair analysis. World J Urol 2014 Dec;32(6):1455-1461.
  30. Ureteroenteric anastomotic strictures after radical cystectomy – does operative approach matter? J Urol 2013 Feb;189(2):541-547.
  31. Laparoscopic and robotic assisted radical cystectomy for bladder cancer: a critical analysis. Eur Urol 2008 Jul;54(1):54-62.
  32. Surgical margin status after robot assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. J Urol 2010 Jul;184(1):87-91.
  33. Robotic and laparoscopic radical cystectomy for bladder cancer: long-term oncologic outcomes. Eur Urol 2014 Jan;65(1):193-200.
  34. Impact of tumur volume on surgical and pathological outcomes after robot-assisted radical cystectomy. BJU Int 2008 Sep;102(7):840-843.
  35. Standardization of radical cystectomy and pelvic lymph node dissection for bladder cancer: a collaborative group report. J Urol 2004 May;171(5):1823-1828; discussion 1827-1828.
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