Laparoscopic Radical Cystectomy Group Research Articles

Comparisons of in-hospital fee and surgical outcomes between robot-assisted, laparoscopic, and open radical cystectomy: a Japanese nationwide study.

To evaluate in-hospital fees and surgical outcomes of robot-assisted radical cystectomy (RARC), laparoscopic radical cystectomy (LRC) and open radical cystectomy (ORC) using a Japanese nationwide database. All data were obtained from the Diagnosis Procedure Combination database between April 2020 and March 2022. Basic characteristics and perioperative indicators, including in-hospital fees, were compared among the RARC, LRC and ORC groups. Propensity score-matched comparisons were performed to assess the differences between RARC and ORC. During the study period, 2931, 1311 and 2435 cases of RARC, LRC and ORC were identified, respectively. The RARC group had the lowest in-hospital fee (median: 2.38 million yen), the shortest hospital stay (26days) and the lowest blood transfusion rate (29.5%), as well as the lowest complication rate (20.9%), despite having the longest anesthesia time (569min) among the three groups (all P<0.01). The outcomes of LRC were comparable with those of RARC, and the differences in these indicators between the RARC and ORC groups were greater than those between the RARC and LRC groups. In propensity score-matched comparisons between the RARC and ORC groups, the differences in the indicators remained significant (all P<0.01), with an ~50 000 yen difference in in-hospital fees. RARC and LRC were considered to be more cost-effective surgeries than ORC due to their superior surgical outcomes and comparable surgical fees in Japan. The widespread adoption of RARC and LRC is expected to bring economic benefits to Japanese society.

Efficiency and Safety of Laparoscopic Radical Cystectomy for Muscle-Invasive Bladder Cancer, and Postoperative Recurrence.

To evaluate the efficiency of open radical cystectomy (ORC) in relation to laparoscopic radical cystectomy (LRC) for muscle-invasive bladder cancer, and incidence of postoperative recurrence. A total of 90 patients with muscle-invasive bladder cancer admitted to our urology department from January 2019 to May 2022 were included in this study. Using the random number table, the patients were assigned equally to ORC and LRC groups. The perioperative data of the patients were collected and recorded. The outcome indicators comprised erythrocyte pressure and creatinine levels, blood gas analysis, type of urinary diversion, and histopathology of surgically removed tumors. Operation time of LRC was significantly longer than that of ORC, but other perioperative indices of LRC were better than those of ORC (p < 0.05). Hematocrit levels in LRC group were higher than those in ORC group at postoperative 1 day and before discharge (p < 0.05). However, creatinine levels were lower in LRC group than in ORC group at postoperative 1 day and before discharge (p < 0.05). Moreover, LRC resulted in better blood gas indices than ORC (p < 0.05). There were no significant differences in the type of urinary diversion and histopathological results from surgically removed tumor between the two groups (p > 0.05). Patients who received LRC had a lower incidence of complications than those given ORC (p < 0.05). LRC reduced perioperative complications, decreased mean length of hospital stays, and enhanced recovery of gastrointestinal and renal functions. These data suggest that LRC is safer and more efficient than ORC. However, further studies are required prior to clinical application of this procedure.

Effect of Radical Laparoscopic Surgery and Conventional Open Surgery on Surgical Outcomes, Complications, and Prognosis in Elderly Patients with Bladder Cancer.

Background Bladder cancer is a common malignant tumor of the urinary system in the clinic. It has multiple lesions, easy recurrence, easy metastasis, poor prognosis, and high mortality. Objective The aim of this study is to investigate the impact of laparoscopic radical cystectomy (LRC) and open radical cystectomy (ORC) on the surgical outcome, complications, and prognosis of elderly patients with bladder cancer. Materials and Methods One hundred elderly bladder cancer patients who underwent surgery in our hospital from June 2019 to June 2021 were selected for the retrospective study and were divided into 50 cases each in the ORC group and the LRC group according to the different surgical methods. The ORC group was treated with ORC, and the LRC group implemented LRC treatment. The differences in surgery, immune function, recent clinical outcomes, and complications between the two groups were observed and compared. Results The mean operative time, mean intraoperative bleeding, intraoperative and postoperative transfusion rate, and transfusion volume of patients in the LRC group were statistically significant when compared to the ORC group. The differences in the meantime to resume eating, time to get out of bed, mean number of days in hospital after surgery, and the amount of postoperative numbing analgesics used by patients in the LRC group after surgery were statistically significant compared to the ORC group (P < 0.05). There was no statistically significant difference in the comparison of immune function between the two groups before surgery (P > 0.05), while the comparison of CD8+ and B cells 1 week after surgery of the LRC group was significantly better than that of the ORC group (P < 0.05), and the operation time of the LRC group was longer than that of the ORC group (P < 0.05). Statistical analysis of postoperative complications showed that the overall incidence of postoperative complications in the LRC group was significantly lower than that in the ORC group (16.67% vs. 46.67%) (P < 0.05). Conclusion LRC has less surgical trauma and intraoperative bleeding, faster postoperative recovery, and fewer postoperative complications, providing some reference for clinical surgery for elderly bladder cancer patients.

Comparison of open and laparoscopic radical cystectomy as regards long-term oncological outcomes for bladder cancer

Objective: Recently, the laparoscopic technique has become widely accepted as a minimally invasive modality which reduces morbidity and provides similar oncological outcomes to open surgery. However, the number of clinical trials comparing laparoscopic and open radical cystectomy are limited. The objectives of this study are to compare the long-term oncological outcomes between open radical cystectomy (ORC) and laparoscopic radical cystectomy (LRC) for bladder cancer. Materials and Methods: Out of 144 radical cystectomy patients admitted to our institute from January 2006 to December 2016, 87 patients were categorized as being in the LRC group, and 57 patients in the ORC group. Baseline characteristics, perioperative variables, and pathology results were collected retrospectively. Oncological outcomes including overall survival (OS), recurrence-free survival (RFS) and cancer-specific survival (CSS) were analyzed and compared between the two groups. Results: The mean age of the patients was 64.19 ± 9.89 years in the ORC group and 61.90 ± 10.47 years in the LRC group. The most frequent urinary diversion procedure in both groups was ileal conduit. All pathology results between the LRC group and the ORC group showed no statistical significance. The median follow-up duration was 57.18 ± 44.68 months in the ORC group and 53.96 ± 34.97 months in the LRC group. There was no statistically significant difference in overall survival (OS), recurrence-free survival (RFS) and cancer-specific survival (CSS) between the groups (p = 0.322, 0.946, and 0.528, respectively). Conclusion: Our study demonstrated that the long-term oncological outcome of LRC is comparable to ORC in the management of bladder cancer. LRC is an alternative option to open radical cystectomy and is safe, effective, and feasible. However, further large comparative studies with adequate long-term follow-up are recommended to support our results.

Three-port approach vs standard laparoscopic radical cystectomy with an ileal conduit: a single-centre retrospective study

BackgroundThis study aimed to evaluate the effect of the three-port approach and conventional five-port laparoscopic radical cystectomy (LRC) with an ileal conduit.MethodsEighty-four patients, who were diagnosed with high-risk non-muscle-invasive and muscle-invasive bladder carcinoma and underwent LRC with an ileal conduit between January 2018 and April 2020, were retrospectively evaluated. Thirty and fifty-four patients respectively underwent the three-port approach and five-port LRC. Clinical characteristics, pathological data, perioperative outcomes, and follow-up data were analysed.ResultsThere were no differences in perioperatively surgical outcome, including pathology type, prostate adenocarcinoma incidence, tumour staging, and postoperative creatinine levels between the two groups. The operative time (271.3 ± 24.03 vs. 279.57 ± 48.47 min, P = 0.299), estimated blood loss (65 vs. 90 mL, P = 0.352), time to passage of flatus (8 vs. 10 days, P = 0.084), and duration of hospitalisation post-surgery (11 vs. 12 days, P = 0.922) were no clear difference between both groups. Compared with the five-port group, the three-port LRC group was related to lower inpatient costs (12 453 vs. 14 134 $, P = 0.021). Our follow-up results indicated that the rate of postoperative complications, 90-day mortality, and the oncological outcome did not show meaningful differences between these two groups.ConclusionsThree-port LRC with an ileal conduit is technically safe and feasible for the treatment of bladder cancer. On comparing the three-port LRC with the five-port LRC, our technique does not increase the rate of short-term and long-term complications and tumour recurrence, but the treatment costs of the former were reduced.

Clinical outcome of laparoscopic versus robot-assisted radical cystectomy for patients with bladder cancer: a retrospective study

BackgroundWith the development of minimally invasive surgery technology, patients with bladder cancer are increasingly receiving laparoscopic radical cystectomy (LRC) or robotic-assisted radical cystectomy (RARC) treatment. The main purpose of this study was to compare the long-term outcomes of bladder cancer patients treated with LRC versus RARC.MethodsA retrospective study to identify patients with clinical stage Ta/T1/Tis to T3 bladder cancer who underwent RARC or LRC has been performed. The perioperative outcome, recurrence, and overall survival (OS) of the two surgical methods were compared.Results218 patients were identified from March 2010 to December 2019 in our department, which including 82 (38%) patients who received LRC and 136 (62%) patients who received RARC. There was no significant difference between the two groups in terms of lymph node collection, lymph node positive rate, resection margin positive rate, and postoperative pathological staging. Compared with the LRC group, patients in the RARC group had a median estimated blood loss (180 vs. 250 ml; P = 0.02) and reduced complications at 90 days postoperatively (30.8% vs. 46.3%; P = 0.01). Recurrence, all-cause death, and cancer-specific death occurred in 77 (35%), 55 (25%), and 39 (18%) patients, respectively. The 5-year OS rate was 54.63% and 54.65% in the RARC and LRC group (P > 0.05). The 5-year cancer-specific survival (CSS) rate was 73.32% and 61.55% in RARC and LRC group (P > 0.05). There was no significant difference in OS [hazard ratio (HR) 1.083, 95% confidence interval (CI) 0.626–1.874; P = 0.78], and CSS (HR 0.789, 95%CI 0.411–1.515; P = 0.61) between two groups.ConclusionsBoth RARC and LRC were safe and effective with a similar long-term clinical outcomes. Moreover, RARC had significantly lower median estimated blood loss and reduced postoperative complications.

Laparoscopic versus open radical cystectomy in 607 patients with bladder cancer: Comparative survival analysis.

ObjectivesTo compare perioperative and oncologic survival outcomes between laparoscopic radical cystectomy and open radical cystectomy.MethodsA total of 607 patients underwent open radical cystectomy (n = 412) or laparoscopic radical cystectomy (n = 195) at a single academic institution from January 2006 to April 2017. Their medical records were retrospectively analyzed. One‐to‐one propensity score matching was carried out to reduce selection bias. Estimated blood loss and complications were compared. Overall survival, cancer‐specific survival and progression‐free survival estimates for all patients and patients with locally advanced bladder cancer were analyzed using the Kaplan–Meier method.ResultsEither before or after matching, the laparoscopic radical cystectomy group had less estimated blood loss (P < 0.001 and P < 0.001) and fewer complications (P < 0.001 and P = 0.008). There was no difference in the overall survival (P = 0.216 and P = 0.961) and progression‐free survival (P = 0.826 and P = 0.462) for all the patients having either laparoscopic radical cystectomy or open radical cystectomy. However, the 5‐year progression‐free survival of open radical cystectomy was higher than that of laparoscopic radical cystectomy (P = 0.019 and P = 0.021) for patients with locally advanced bladder cancer.ConclusionsLaparoscopic radical cystectomy is superior to open radical cystectomy in terms of perioperative outcomes, and similar to open radical cystectomy in terms of oncologic outcomes for patients with early stage bladder cancer. However, for patients with locally advanced bladder cancer, laparoscopic radical cystectomy seems to be associated with shorter progression‐free survival than open radical cystectomy.

The Utility and Efficacy of Laparoscopic Radical Cystectomy in Patients with Muscle-Invasive Bladder Cancer at a Single Institution

Background: The aim of this study was to compare the surgical and oncological outcomes and complications of laparoscopic radical cystectomy (LRC) to those of open radical cystectomy (ORC) in patients with muscle-invasive bladder cancer (MIBC). Methods: Our study focused on patients with histologically confirmed stage T2–T4a urothelial carcinoma of the bladder without distant metastases, who underwent LRC (LRC group) or ORC (ORC group). The primary endpoints in this study were the overall survival (OS) and recurrence-free survival (RFS) rates. Results: In this study, 59 patients, 17 underwent LRC and 42 underwent ORC, were enrolled. The 2-year OS rate was 100% in the LRC group and 88.0% in the ORC group (p = 0.85). The 2-year RFS rate was 63.5% in the LRC group and 69.5% in the ORC group (p = 0.321). On multivariate analysis, the histological type, positive lymph node, and positive resection margin were significantly associated with the OS rates. Conclusions: This study suggested that LRC may achieve similar oncological outcomes and fewer perioperative complications and less blood loss compared to ORC. Therefore, LRC should be considered as one of the treatment options for patients with MIBC.

P0570THE INCIDENCE, RISK FACTORS OF ACUTE KIDNEY DISEASES AND DISORDERS AND ITS IMPACT ON CHRONIC KIDNEY DISEASE IN PATIENTS AFTER RADICAL CYSTECTOMY

Abstract Background and Aims Acute kidney injury (AKI) is a widely-discussed complication associated with the radical cystectomy which is the gold standard for the management of invasive bladder cancer. Until now, few studies investigate the new criteria named Acute Kidney Diseases and Disorders(AKD) as the complication of radical cystectomy. In this study, we evaluated the incidence, risk factors of AKD and evaluate its impact on chronic kidney disease (CKD) in patients after radical cystectomy. Method A total of 279 patients who underwent radical cystectomy at Sun Yat-sen Memorial Hospital, Guangzhou, China, from January 2006 to June 2019 were evaluated, including 168 patients for Robotic-assisted Laparoscopic Radical Cystectomy (RLRC) and 111 patients for Laparoscopic Radical Cystectomy(LRC). AKD was diagnosed according to the classification scheme proposed in the 2012 KDIGO guideline. Logistic regression modeling was used to explore risk factors of AKD, while risk factors associated with CKD in AKD patients were investigated using Kaplan-Meier analysis, respectively. Results The overall incidence of AKD after radical cystectomy was 34.1% (95 out of 279) ,the incidences differ significantly between the RLRC and LRC groups (67 [39.9%] vs 28 [25.2%], P=0.011). Among 279 patients, risk factors associated with postoperative AKD included RLRC (OR 2.067, 95%CI 1.188 to 3.595, P=0.010), Age (years) (OR 1.046, 95%CI 1.018 to 1.074, P=0.001), baseline eGFR&amp;lt;60(ml/(min.1.73m2) (OR 2.662, 95%CI 1.355 to 5.230, P=0.004), Further subgroup analysis identified age, operation time&amp;lt;250(min) as important risk factors of AKD in RLRC patients but not in LRC patients. Of 211 patients with a preoperative estimated glomerular filtration rate (eGFR) of &amp;gt; 60 ml/min/1.73 m2, CKD developed in 16.0% (21/ 131) of patients in the non-AKD group and 36.3% (29/ 80) of patients in the AKD group. Kaplan-Meier analysis(shown in figure 1) identified that AKD is associated with higher CKD rates in those patients (P &amp;lt;0.001). Conclusion One-third of bladder cancer patients developed AKD after after radical cystectomy. RLRC, Age, baseline eGFR &amp;lt;60(ml/(min.1.73m2) were independent risk factors for postoperative AKD in all patients. Occurance of AKD could increase the risk of new-onset CKD in the long run. Though the use of RLRC is now well established, we should be aware that it may increase the risk of postoperative AKD, especially for patients who are old and with lower eGFR .Besides, we should try to improve the management of those AKD patients with aim toward preventing further development of CKD.

Laparoscopic versus open radical cystectomy in the treatment of locally advanced T3 and T4 bladder cancer: Perioperative and Mid-term oncological outcomes

In this study, we aim to compare the perioperative and midterm oncological outcomes in patients with advanced bladder cancer and those who had laparoscopic radical cystectomy (LRC) and open radical cystectomy (ORC). We retrospectively reviewed medical records of patients who underwent LRC or ORC in a single center between 2008 and 2014 with a pathological diagnosis of pT3 and pT4 bladder cancer. Thirty-five and 39 patients were included in the study as part of the LRC and ORC groups, respectively. There was no statistically significant difference between the two groups in terms of disease-free survival (LRC, 39.8±4.86 months; ORC, 45.47±8.92 months, P=0.896). Average estimated blood loss and length of hospitalization were significantly less in the LRC group. The overall survival rates of patients at 1, 2, and 3 years were 73%, 46%, and 46% in the ORC group and 78%, 65%, and 40% in the LRC group, respectively, and there was no statistically significant difference between the two groups. One patient in the ORC group experienced rectal injury in the form of a serosal tear, which was repaired primarily without any postoperative sequelae. There were no conversions in the laparoscopic group. Similarly, in 1 patient, rectal serosal tear was repaired preoperatively. Our study showed that LRC provides midterm oncological outcomes similar to ORC in the treatment of locally advanced T3 and T4 bladder cancer. However, long-term oncological and functional outcomes are required.

Laparoscopic versus open radical cystectomy for patients with bladder cancer over 75-year-old: a prospective randomized controlled trial.

The aim of this study was to compare the morbidity, mortality, oncological results and quality of life between laparoscopic radical cystectomy (LRC) and open radical cystectomy (ORC) in the elderly patients over 75 years old. Between January 2012 and January 2015, 60 patients were recruited into this study, who were randomly assigned in a 1:1 ratio to either LRC or ORC group. Baseline patient characteristics, pathological factors, operative and postoperative characteristics, postoperative complications and survival data were retrospectively collected, analyzed and compared between the two groups. Patients in LRC group and ORC group had comparable baseline characteristics and pathological factors (all P > 0.05). LRC group required longer operative time (408.2 ± 76.9 vs. 311.7 ± 65.3 min, P = 0.000) and had less EBL (621.6 ± 100.7 vs. 1088.5 ± 109.4 ml, P = 0.000) compared with ORC group. The incidence of infection and ileus within 90 days after surgery in ORC group was significantly higher than LRC group(6.9% vs. 28.6%, P = 0.041; 3.4% vs. 25%, P = 0.025). At a median follow-up of 28 months (range 12–48 months), the survival analysis showed that there were no significant differences between the LRC and ORC groups in overall survival (log-rank χ2 = 0.122; P = 0.726), or progress-free survival (log-rank χ2 = 0.153; P = 0.696). In conclusion, this study confirmed that LRC could achieve similar tumor treatment efficacy compared to ORC, with fewer perioperative complications and less blood loss. We suggest that LRC should be considered as the primary intervention for patients aged over 75 years old with muscle invasive bladder cancer or non-muscle invasive bladder cancer with high risk factors.

Laparoscopic Radical Cystectomy in the Elderly - Results of a Single Center LRC only Series.

ABSTRACTObjective:To compare outcome of laparoscopic radical cystectomy (LRC) with ileal conduit in 22 elderly (≥75 years) versus 51 younger (<75 years) patients.Materials and Methods:Analysis of prospectively gathered data of a single institution LRC only series was performed. Selection bias for LRC versus non-surgical treatments was assessed with data retrieved from the Netherlands Cancer Registry.Results:Median age difference between LRC groups was 9.0 years. (77.0 versus 68.0 years). Both groups had similar surgical indications, body mass index and gender distribution. Charlson Comorbidity Index score was 3 versus 4 in ≥50% of younger and elderly patients. Median operative time (340 versus 341 min) and estimated blood loss (<500 versus >500mL) did not differ between groups. Median total hospital stay was 12.0 versus 14.0 days for younger and elderly patients. Grade I-II 90-d complication rate was higher for elderly patients (68 versus 43%, p=0.05). Grade III-V 90-d complication rate was equal for both groups (23 versus 29%, p=0.557). 90-d mortality rate was higher for elderly patients (14 versus 4%, p=0.157). Median follow-up was 40.0 months for younger and 57.0 months for elderly patients. Estimated overall and cancer-specific survival at 5years. was 46% versus 35% and 64% versus 64% for younger and elderly patients respectively.Conclusions:Our results suggest that LRC is feasible in elderly patients, where a non-surgical treatment is usually favoured.

Comparison of early stage complications between laparoscopic cystectomy and open radical cystectomy

Objective To compare the incidence and characteristics of early stage complications between laparoscopic radical cystectomy (LRC) and open radical cystectomy (ORC). Methods From September 2011 to May 2014, we retrospectively analyzed the demographic, perioperative data of 96 (86 males and 10 females) and 105 (86 males and 19 females) patients who had undergone LRC and ORC, respectively. The average age of patients was(64.4±11.4)and (63.7±10.5)years old in ORC and LRC group, respectively. We collected operation time, estimated blood loss, number of transfusion, time to resumption of oral intake, postoperative length of drainage freeand complication rate within 90 days after cystectomy.Categorical variables were analyzed with the 2 test or Fisher′s exact test as appropriate. Continuous variables were compared using the Student′s t-test. Results Mean operative time was significantly longer in LRC group than ORC group (389 vs 321 min, P=0.02). However mean estimated blood loss, postoperative length of stay was significantly less in LRC group than in ORC group(420 vs 591 ml, P=0.003 and 16.5 vs 18.5 d, P=0.04), respectively. Fewer patients in the LRC group need blood transfusion than in ORC group (15 vs 29 patients, P=0.042). The complication rate was significantly less in LRC group as well (28.1% vs 43.8%, P=0.027). No significant differences were found in time resume the intestinal function(3.7 vs 3.5 d), time to resumption of oral intake (4.4 vs 4.3 d)and time to remove the drainage tube (11.1 vs 10.9 d) between two groups, respectively (P>0.05). The incidence of early complication in LRC group was significant lower than that in ORC group(28.1% vs 43.8%, P<0.05). The common complications following LRC were infection (n=7), intestinal obstruction(n=7), lymphatic leak(n=7), while ORC group was infection(n=14), intestinal obstruction (n=13) and liquefied fat (n=11). The incidence of liquefied fat of abdominal incision was significantly less in the LRC group than ORC group (1 vs 11 patients, P=0.006). Conclusion Patients can benefit more from LRC than ORC, because LRC can help to reduce estimated blood loss, postoperative transfusion and complication as well as postoperative length of stay. Key words: Bladder cancer; Laparoscopes; Open; Radical cystectomy; Complications

Laparoscopic Radical Cystectomy Versus Extraperitoneal Radical Cystectomy: Is the Extraperitoneal Technique Rewarding?

BackgroundTo study whether extraperitoneal radical cystectomy (EORC) accelerates the postoperative recovery of bowel function compared with laparoscopic radical cystectomy (LRC). Patients and MethodsAll the patients with bladder cancer who underwent EORC or LRC with an ileal conduit by a single surgeon from January 2009 to June 2014 were investigated. The perioperative outcomes and follow-up data were analyzed, with a focus on postoperative ileus (POI). ResultsA total of 41 LRCs and 53 EORCs met the inclusion criteria. LRC was associated with a significant reduction in the estimated blood loss (278 vs. 356 mL, P = .017) and a shorter hospital stay (8.1 vs. 9.2 days, P = .003). However, LRC was also associated with longer operative times (349 vs. 316 minutes, P = .022). The incidence of paralytic POI was 7.3% (3 of 41) and 7.5% (4 of 53; P = .966) and the obstructive POI rate was 4.9% (2 of 41) and 3.8% (2 of 53; P = .792) for the LRC and EORC groups, respectively. No significant differences were noted in blood transfusion requirements, interval to flatus or liquid intake, or opioid dosage. No patient in either group had positive surgical margins, and no significant differences were observed in the lymph node count (P = .112). At a median follow-up period of 28.7 months (range, 3-62 months), no significant differences were seen between the LRC and EORC groups in the 3-year overall, cancer-specific, or cancer-free survival rates. ConclusionEORC resulted in a POI rate similar to that of LRC, despite factors favoring LRC. Our results suggest that extraperitoneal LRC could improve the perioperative outcomes.

AB117. Laparoscopic versus open radical cystectomy for elderly patients over 75-year-old: a single center comparative analysis

PurposeTo explore the morbidity, mortality and oncological results of laparoscopic radical cystectomy (LRC) in the elderly patients over 75-year-old in contrast with open radical cystectomy (ORC).Materials and methodsWe analyzed 46 radical cystectomies from January 2009 to December 2013 in patients over 75-year-old in our institute, 21 patients in the LRC group and 25 in the ORC group. Demographic parameters, operative variables and perioperative outcome were retrospectively collected and analyzed between the two groups. Perioperative morbidity and mortality were categorized as early (within 90 days after surgery) or late (more than 90 days) according to the time of occurrence.ResultsPatients in both groups had comparable preoperative characteristics. A significant longer operative time (418 vs. 337 min, P=0.018) and less estimated blood loss (400 vs. 500 mL, P=0.038) were observed in LRC group compared with ORC group. Infection and ileus were the most common early complications after surgery. Patients underwent ORC suffered from significantly more postoperative ileus (28.0% vs. 4.8%, P=0.038) and infection (40% vs. 9.5%, P=0.019) than LRC group within 90 days after surgery. The mortality rate was 4.7% (1/21) and 4% (1/25) for LRC group and ORC group respectively. At a median follow-up of 21 months (range, 2-61 months), the Kaplan-Meier survival curves and log-rank analysis demonstrate that there were no significant differences between the LRC and ORC groups in the 3-year overall, cancer-specific, or recurrence-free survival rates.ConclusionsIt is suggested that LRC should be recommended as the primary intervention to treat muscle invasive or high risk non-muscle invasive bladder cancerin elderly patients with a relative long life expectancy.

What About Conventional Laparoscopic Radical Cystectomy? Cost-Analysis of Open Versus Laparoscopic Radical Cystectomy

To assess direct healthcare costs for open radical cystectomy (ORC) vs laparoscopic radical cystectomy (LRC) with ileal conduit. A series of 44 and 42 patients undergoing ORC and LRC with ileal conduit were retrospectively analyzed at a single institution from January 2005 to January 2012. The ORC and LRC procedures were performed by two independent surgical teams; there was no selection in patients. Data on patient demographics, perioperative outcome parameters, complications, and readmissions were gathered retrospectively in the ORC series and prospectively in the LRC series. Direct healthcare costs were evaluated for operating room occupation, disposable surgical equipment, blood transfusions, hospital stay according to intensity of care, and readmission days. Mean and median evaluated total direct healthcare costs per patient did not differ significantly and were 17,534€ and 16,511€ in the LRC group and 22,284€ and 15,909€ in the ORC group. Excess costs for disposable surgical equipment and operating room occupation within the LRC group were compensated for as a result of shorter hospital stay, lower number of blood transfusions, and intensive-care admissions. Minor and major complication rates were comparable between groups. Within our series, LRC is a cost neutral minimally invasive alternative to ORC without comprising quality of care and with beneficial perioperative outcomes.

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

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.

当院における腹腔鏡下膀胱全摘除術の治療成績

The standard care for invasive bladder cancer is radical cystectomy with urinary diversion, but laparoscopic radical cystectomy (LRC) is still being evaluated. We describe our initial experience of laparoscopic radical cystectomy compared to open radical cystectomy (ORC). From January 2000 to June 2012, 84 patients underwent radical cystectomy by ORC (n = 54) or LRC (n = 30). Treatment outcomes including surgical and oncological outcomes between LRC and ORC were compared. We also assessed learning curve during LRC as to blood loss, operating time and complication rate. The patients' characteristics were similar in LRC and ORC groups except for ASA score. Importantly, Operating time during LRC was longer but complication rate of LRC was lower than that of ORC (586 min vs 424 min and 40% vs 69%, respectively). In addition, pathological stage or outcomes were similar in both groups and there were no significant difference between LRC and ORC groups in terms of overall and recurrence free survival rate. As for learning curve of LRC, operating time and blood loss tended to decrease with increased experience. These results indicate that LRC could be performed safely with decreased complication rate and similar oncological outcomes compared to ORC.

939 DIVERSION RELATED COMPLICATIONS AFTER LAPAROSCOPIC AND OPEN RADICAL CYSTECTOMY

You have accessJournal of UrologyUrinary Diversion: Bladder Reconstruction, Augmentation, Substitution, Diversion II1 Apr 2010939 DIVERSION RELATED COMPLICATIONS AFTER LAPAROSCOPIC AND OPEN RADICAL CYSTECTOMY Ricardo Brandina, Andre Berger, Alvaro Bosco, Monish Aron, Mihir Desai, Inderbir S. Gill, and Steven Campbell Ricardo BrandinaRicardo Brandina Los Angeles, CA More articles by this author , Andre BergerAndre Berger Los Angeles, CA More articles by this author , Alvaro BoscoAlvaro Bosco Cleveland, OH More articles by this author , Monish AronMonish Aron Los Angeles, CA More articles by this author , Mihir DesaiMihir Desai Los Angeles, CA More articles by this author , Inderbir S. GillInderbir S. Gill Los Angeles, CA More articles by this author , and Steven CampbellSteven Campbell Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1818AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Open radical cystectomy (ORC) is the gold standard treatment for muscle-invasive bladder cancer. Laparoscopic radical cystectomy (LRC) with extracorporeal reconstruction is a minimally invasive alternative for the management of this disease. However, relatively short ureteral length and body habitus may make the diversion more challenging and could theoretically predispose to ureteral strictures and other diversion related complications. Herein we compare diversion related complications in patients who underwent ORC and LRC. METHODS A retrospective review was undertaken of 151 patients managed with either LRC (extracorporeal diversion) or ORC performed between August 2005 and November 2008. Diversion related and other clinical parameters were obtained from patient charts and review of the Social Security Death Index. RESULTS There were no significant differences between the LRC (n=64) and ORC (n=87) group with respect to mean patient age (70 vs. 69; p =0.7), BMI (28 vs. 28; p= 0.9), sex, ASA class, and operative indications. The ORC group had a higher prevalence of CKD and smoking history. The distribution of urinary diversions was similar between LCR (46 ileal conduit, 12 orthothopic neobladder, 6 continent cutaneous) and ORC groups (66 ileal conduit, 13 orthotopic neobladder, 8 continent cutaneous). The pathological findings were organ confined tumor (≤pT2 or less) or non-organ confined tumor (pT3-4) in 67% and 33% of the LCR cases and 58% and 42% of the ORC cases, respectively (p=0.25). The number of nodes retrieved was higher in ORC group (24 vs. 17, p=0.03). There were no differences between overall intraoperative complications (3% vs. 3%) and postoperative minor (21% vs. 31%, p=0.21) and major complications (8% vs. 7%, p=0.8). Seventeen diversion related complications were identified including: LRC (n = 9, 14%) with 7 ureteral stenosis, 1 total incontinence after neobladder requiring AUS, 1 urinary fistula requiring percutaneous bilateral nephrostomy tubes; ORC (n =8, 9.1%) with 6 ureteral stenosis, 1 neobladder disruption and 1 enteroureteral fistula. CONCLUSIONS Diversion related complications were marginally increased with LRC compared to ORC, although these evaluations did not reach statistical significance. © 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e366 Peer Review Report Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ricardo Brandina Los Angeles, CA More articles by this author Andre Berger Los Angeles, CA More articles by this author Alvaro Bosco Cleveland, OH More articles by this author Monish Aron Los Angeles, CA More articles by this author Mihir Desai Los Angeles, CA More articles by this author Inderbir S. Gill Los Angeles, CA More articles by this author Steven Campbell Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Laparoscopic versus open radical cystectomy for the management of bladder cancer: Mid‐term oncological outcome

To compare the mid-term oncological outcome of laparoscopic radical cystectomy (LRC) with those of open radical cystectomy (ORC). From June 2003 to February 2008, 36 LRCs were carried out at our institute for the treatment of bladder cancer. Clinical and oncological data were retrospectively analyzed. A match-pair comparison with an historical series of 34 patients who were submitted to ORC between 1996 and 2003 was carried out. Median follow-up of the LRC group was 21 months (3-56 months). Pathological stage or grade was similar in the two groups. There was no significant difference between the LRC and ORC groups in terms of 3-year overall (64.2% vs 72.6%, respectively; P = 0.682), cancer-specific (73.0% vs 75.3%, respectively; P = 0.951), and recurrence-free survival (70.5% vs 72.5%, respectively; P = 0.715) rates. In a subgroup analysis according to stage, there was also no significant difference in the 3-year disease-specific survival after LRC or ORC for organ-confined (pT1 and pT2; 85.7% vs 83.9%, respectively; P = 0.256) or extravesical disease (pT3 and pT4; 73.3% vs 63.8%, respectively; P = 0.825). These findings suggest that LRC provides mid-term oncological outcomes similar to those of ORC in the management of bladder cancer.