Safety and Feasibility of Laparoscopic Radical Cystectomy for the Treatment of Bladder Cancer

Abstract

Radical cystectomy is the mainstay of the management of muscle invasive bladder cancer. Numerous centers have adopted a minimally invasive approach to replace the standard open procedure. The objective of the study was to review published literature comparing laparoscopic radical cystectomy (LRC) and open radical cystectomy (ORC). A systematic review of the literature according to Cochrane guidelines was conducted (1993 to 2012) for studies comparing LRC and ORC. All studies comparing the two procedures were included. The outcome measures were the patient demographics, operative time, blood loss, transfusion rates, time to oral intake, length of hospital stay, and complications. A meta-analysis was conducted. For continuous data, a Mantel-Haenszel chi-square test was used, and for dichotomous data, an inverse variance was used, each expressed as risk ratio with 95% confidence interval. P<0.05 was considered significant. Four hundred twenty-seven patients were included-211 patients in the laparoscopic group and 216 patients in the open group (eight studies). There was no significant difference between the two groups in any of the demographic parameters except for age (age: P<0.0001; sex: P=0.1; body mass index: P=0.05). The laparoscopic group had significantly longer operative times (P<0.0001), but less blood loss (P<0.00001), less transfusion rates (P<0.0001), less time to oral intake (P<0.0001), less analgesic requirement (P=0.0009), and shorter length of hospital stay (P<0.0001). Significantly more minor complications developed in the ORC group than in the LRC group (P=0.02). There was no difference between the two groups regarding lymph node dissection yields, major complications, positive margins, pathologic results, local recurrence, or distant metastases (all P>0.05). There were significantly more positive nodes in the ORC group, however. In experienced hands, LRC is a feasible and safe alternative to ORC with less blood loss, transfusion and analgesic requirement, shorter lengths of hospital stay, and less complications. LRC does, however, have longer operative times.