Safety Of Laparoscopic Radical Cystectomy Research Articles

Feasibility and safety of laparoscopic radical cystectomy for male octogenarians with muscle-invasive bladder cancer

This study was designed to evaluate the safety and feasibility of laparoscopic radical cystectomy (LRC) for male octogenarian patients with muscle-invasive bladder cancer (MIBC). Briefly, a total of 57 male octogenarian patients (A group) with bladder carcinoma were enrolled and underwent LRC and intracorporeal pelvic lymph node dissection with bilateral cutaneous ureterostomy from May 2016 to December 2022. Besides, 63 male patients (age < 80 years old) with bladder carcinoma undergoing LRC and 17 octogenarian male patients with bladder carcinoma undergoing open radical cystectomy (ORC) were enrolled in B and C groups as control. All perioperative clinical materials and outcomes of long-term follow-up, and complication were collected. The specific results were shown as follows. Compared with C group, the operation time and resected lymph node in A group was increased, and the estimated blood loss, the number of transfusion needed, duration of pelvic drainage and hospital stay after surgery was decreased. The death rate and ileus complication rate were higher in A group (12 cases) than in C group (15 cases). The cases of ureteral stricture in A group (13 cases) was decreased compared with that in C group. Overall, LRC and bilateral cutaneous ureterostomy are safe, feasible and better choices for the treatment of male octogenarian patients with MIBC. The octogenarian receiving cutaneous ureterostomy heals slowly and exists certain incomplete intestinal obstruction after surgery.

Perioperative comparison between robot-assisted and laparoscopic radical cystectomy: An update meta-analysis.

We conducted this study to explore the efficacy and safety of laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) for bladder cancer (BC).We searched the PubMed, Embase, Cochrane Library and Web of Science databases for studies on LRC and RARC treatment of BC from the time of the databases creation to May 1, 2022. We extracted data and used Stata 16.0 for calculation and statistical analyses.Thirteen studies with 1509 patients were included. Meta-analysis showed no statistically significant differences (P>0.05) between RARC and LRC in terms of operative time (weighted mean difference [WMD]=14.48; 95% confidence interval [CI][-2.49, 31.44], P=0.001), estimated intraoperative blood loss (WMD=-4.23; 95% CI [-81.48, 73.01], P=0.001), intraoperative blood transfusion (odds ratio [OR]=0.7; 95% CI [0.39, 1.27]; P=0.011), positive surgical margins (OR=1.21; 95% CI [0.61, 2.03]; P=0.855), time to regular diet, length of hospital stay (WMD=0.37, 95% CI [-1.73, 2.46]; P=0.001), postoperative hospital days (WMD=-0.52; 95% CI [-1.15, 0.11], P=0.359), intraoperative complications, 30- day postoperative complications, and 90- day postoperative complications. However the RARC lymph node yield was higher than that of LRC (WMD=1.87; 95% CI [0.74, 2.99], P=0.147).Our study showed that LRC and RARC have similar efficacy and safety profiles for the treatment of muscle invasive bladder cancer.

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.

Comparative analysis of the clinical effect and safety of Laparoscopic Radical Cystectomy + Orthotopic Ileal Neobladder and Open Surgery.

Objectives:To explore the clinical effect and safety of laparoscopic radical cystectomy + orthotopic ileal neobladder and open surgery.Methods:The study was conducted at Jingzhou First People’s Hospital from January 2017 to July 2018. In this study 87 patients undergoing radical cystectomy + orthotopic ileal neobladder were chosen and classified into an observation group (48 cases) and a control group (39 cases) according to the surgical methods. The observation group underwent laparoscopic surgery, while the control group underwent open surgery. Perioperative period and prognostic conditions were compared in both groups.Results:The intraoperative bleeding amount obviously decreased. The recovery time of gastroenteric function and postoperative hospitalization time were significantly shortened. Postoperative pain was significantly alleviated. Compared with the control group, the observation group showed significant differences (P<0.05). The time, amount and difference in pelvic lymph node dissection in both groups were not significantly different (P>0.05). The differences in both groups in terms of the daytime/nighttime urinary continence rate, maximum urinary flow rate, internal bladder pressure, maximum bladder pressure during urination, internal urethral pressure, bladder capacity, and residual urine volume six months after the operation were not statistically significant (P>0.05). There was no significant difference in postoperative complications, including urinary fistula, bleeding, urinary tract infection, pulmonary infection, dysuria, lymphatic leakage, ureterostenosis, or relapse (P>0.05). The ileus incidence rate in the observation group was obviously lower than that in the control group, and the difference was statistically significant (P<0.05).Conclusion:Laparoscopic radical cystectomy + orthotopic ileal neobladder has the characteristics of limited trauma, a minimal amount of bleeding and a fast recovery. The functions of orthotopic neobladders are good, and the occurrence rate of postoperative complications is low. In addition, body immunity is protected. Hence, this procedure deserves to be promoted clinically.

The Safety of Laparoscopic Radical Cystectomy during Initial Phases in a Japanese Multicenter Cohort

We evaluated the safety of laparoscopic radical cystectomy (LRC) during initial phases and its learning curve in a Japanese multicenter cohort by studying 436 patients who underwent LRC with no robot assistance at 10 institutions in Japan. We divided the patients into three groups according to cumulative surgical volume at each institution (first 10 cases, 11-30 cases, after 31 cases in each institution), and compared perioperative and pathologic variables among the three groups. The first, second, and third groups included 100, 166, 170 patients, respectively. The preoperative variables were similar in the three groups except for the rate of neoadjuvant chemotherapy. The methods of LRC procedure, such as urinary diversion, the extent of lymph node dissection, and concomitant urethrectomy or nephroureterectomy, were similar in the three groups. Mean operative time was 629, 562 and 531 minutes, respectively, and mean blood loss was 755, 650 and 435 ml, respectively. Both values decreased over time with the institution's experience. There was no significant difference among the three groups in the rate of positive surgical margin, the number of retrieved lymph nodes, and the rate of intra- and postoperative complications. LRC was safely performed during initial phases with an acceptable complication rate and without compromising oncological results, although operative time was longer and blood loss increased.

Safety of laparoscopic radical cystectomy in clinical T4 very high risk prostate cancer patients

Safety of laparoscopic radical cystectomy in clinical T4 very high risk prostate cancer patients

Clinical efficacy and complications of laparoscopic radical cystectomy with orthotopic ileal neobladderin for treatment of bladder cancer

Objectives To explore the clinical efficacy and safety of laparoscopic radical cystectomy with orthotopic ileal neobladderin in the treatment of patients with bladder cancer. Methods 70 patients underwent radical cystectomy with orthotopic ileal neobladder in our hospital from January 2009 to March 2014 were selected as the research object, including 30 patients underwent laparoscopic operation as the observation group, and 40 patients underwent open operation as control group.Indexes of perioperation period, the new bladder function and total complications were compared in two groups. Results Observation group hospitalization time, recovery time of gastrointestinal function, amount of bleeding in the observation group were less than control group, there was statistically significant difference(P 0.05). Total complication rate of observation group(16.7%) was significantly lower than that of control group(37.5%), and there was statistically significant difference between the two groups(χ2=4.642, P<0.05). Conclusions Laparoscopic radical cystectomy with orthotopic ileal neobladder has the advantages of minima1 trauma, less bleeding, rapid recovery, good bladder function and low complications.It is worth popularizing application in clinical. Key words: Urinary Bladder Neoplasms; Cystectomy; Laparoscopes; Urinary Diversion

Laparoscopic Radical Cystectomy With Intracorporeal Orthotopic Ileal Neobladder: Technique and Clinical Outcomes

To study the feasibility and safety of laparoscopic radical cystectomy with intracorporeal orthotopic ileal neobladder and to evaluate the role of endoscopic stapling in neobladder construction. Fifty-five patients with bladder cancer who underwent laparoscopic radical cystectomy were retrospectively examined. Extended pelvic lymph node dissection was performed before cystectomy. An ileal segment of 50cm was harvested to construct a U-shaped reservoir. The bottom of the reservoir was anastomosed with the posterior urethra. Twenty-five patients underwent neobladder construction by manual suturing and 30 patients by endoscopic stapler suturing. The mean operative time was 346minutes, and mean neobladder construction time was 230minutes. The median estimated blood loss was 500mL, and 17 patients received intraoperative transfusion. Postoperative complications included 2 cases of urine leakage, 7 cases of pyelonephritis, 4 cases of incomplete bowel obstruction, 1 case of anastomotic stricture, and 1 case of death. Endoscopic stapler suturing for neobladder construction took significantly less time than manual suturing. However, neobladder stones were found in 2 patients who underwent operation using endoscopic suturing, and the stones were removed cystoscopically. The functional outcomes of the 2 constructive methods were comparable. Laparoscopic radical cystectomy with intracorporeal orthotopic neobladder is safe and feasible for experienced laparoscopic surgeons. Application of endoscopic stapler simplifies the surgical procedure while increasing the risk of neobladder stone formation.

Long-term analysis of oncological outcomes after laparoscopic radical cystectomy in Europe: results from a multicentre study by the European Association of Urology (EAU) section of Uro-technology.

To report long-term outcomes of laparoscopic radical cystectomy (LRC) in a multicentre European cohort, and explore feasibility and safety of LRC. This study was coordinated by European Association of Urology (EAU)-section of Uro-technology (ESUT) with nine centres enrolling 503 patients undergoing LRC for bladder cancer prospectively between 2000 and 2013. Data were retrospectively analysed. Descriptive statistics were used to explore peri- and postoperative characteristics of th ecohort. Kaplan-Meier curves were constructed to evaluate recurrence-free survival (RFS), cancer-specific survival (CSS) and overall survival (OS). Outcomes were also stratified according to tumour stage, lymph node (LN) involvement and surgical margin status. Minor complications (Clavien I-II) occurred in 39% and major (IIIa-IVb) in 17%. In all, 10 (2%) postoperative deaths were recorded. The median (interquartile, IQR) LN retrieval was 14 (9-17) and positive surgical margins were detected in 29 (5.8%) patients. The median (mean, IQR) follow-up was 50 (60, 19-90), during which 134 (27%) recurrences were detected. Actuarial RFS, CSS and OS rates were 66%, 75% and 62% at 5 years and 62%, 55%, 38% at 10 years. Significant differences in RFS, CSS and OS were found according to tumour stage, LN involvement and margin status (log-rank P < 0.001). On multivariate Cox analysis, T stage and LN involvement (both P < 0.001) were significant predictors of RFS, CSS and OS. Positive margins were significant predictors of RFS (P = 0.016) and CSS (P = 0.043). In this European LRC multicentre study, the largest to date, long-term RFS, CSS and OS rates after LRC appear comparable to those reported in current open RC series. Further randomised controlled trials are necessary to assess the global impact of LRC.

Short Term Comparative Analysis of Laparoscopic and Open Radical Cystectomy with Extracorporeal Urinary Diversion

Purpose: We analyzed the efficacy and safety of laparoscopic radical cystectomy (LRC) compared with open radical cystectomy (ORC). Materials and Methods: Between November 2007 and April 2009, we performed LRC to treat bladder cancer in 23 patients and ORC in 64 patients. Data including the patients’ clinical characteristics, peri-operative parameters, clinical outcomes, and oncologic outcomes were collected retrospectively and analyzed by use of the Mann-Whitney U test and chi-square test. Results: There were no significant differences in demographic data between the two groups. Operative time was longer (595.2 min vs. 453.1 min; p<0.01) in the LRC group but blood loss was less (634.8 ml vs. 1,415.9 ml; p<0.01) and fewer transfusions were required (13.0% vs. 50.0%; p=0.002) in the LRC group. Days to oral intake (5.7 days vs. 7.3 days; p<0.01), days to drain removal (10.9 days vs. 13.9 days; p=0.014), and length of hospital stay (15.2 days vs. 22.3 days; p<0.01) were shorter in the LRC group. Postoperative complications occurred in 4 cases in the LRC group and 28 cases in the ORC group (17.4% vs. 43.8%, p<0.01). There were no cases with a positive surgical margin in the LRC group and 3 cases in the ORC group. There was no significant difference in the number of lymph nodes excised (17.4 vs. 19.6; p=0.132) between groups. Conclusions: These short-term clinical and oncological results suggest that LRC is a safe and effective method for the treatment of invasive bladder cancer. (Korean J Urol 2009;50:1083-1088) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏