Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 1.736
5-Year Impact Factor – 2.135
Index Copernicus  – 168.52
MEiN – 70 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

Download original text (EN)

Advances in Clinical and Experimental Medicine

2020, vol. 29, nr 3, March, p. 301–306

doi: 10.17219/acem/115084

Publication type: original article

Language: English

License: Creative Commons Attribution 3.0 Unported (CC BY 3.0)

Download citation:

  • BIBTEX (JabRef, Mendeley)
  • RIS (Papers, Reference Manager, RefWorks, Zotero)

Can laparoscopic cystectomy become the method of choice in the treatment of invasive urothelial urinary bladder cancer?

Przemysław Adamczyk1,A,C,D,F, Kajetan Juszczak2,C,E, Mateusz Kadłubowski1,B, Adam Ostrowski3,B, Piotr Maciukiewicz2,E, Tomasz Drewa3,F

1 Department of General and Oncologic Urology, Nicolaus Copernicus Hospital in Toruń, Poland

2 Department of Urology, Memorial Rydygier Hospital, Kraków, Poland

3 Clinic of General and Oncologic Urology, Collegium Medicum of Nicolaus Copernicus University, Bydgoszcz, Poland

Abstract

Background. Radical cystectomy with pelvic lymphadenectomy is the method of choice for muscle-invasive urothelial cell cancer (UCC) treatment and provides the best cancer-specific survival. It can be performed as an open radical cystectomy (ORC), laparoscopic radical cystectomy (LRC) or robot-assisted surgery (RARC).
Objectives. The aim of this study was to compare laparoscopic and open radical cystectomy in terms of perioperative and oncological results.
Material and Methods. This retrospective study included 260 patients who underwent surgery due to invasive bladder cancer. A laparoscopic radical cystectomy (LRC) was performed on 131 patients and an open radical cystectomy (ORC) on 129 patients. Group was stratified according to the urinary diversion. Oncologic results expressed as perioperative variables were analyzed, adjusted to the type of urinary diversion.
Results. The LRC patients were in worse perioperative condition according to the American Society of Anesthesiologists (ASA) score than the ORC group (3.1 and 2.52, respectively; p = 0.001). The serum protein level was significantly lower in the ORC group, with no difference in body mass index (BMI) between the groups. The median operation time was significantly shorter in the LRC group with ileal conduit and uretero-cutaneostomy than in the same groups operated using open approach (252.5 min and 180 min vs 290 min and 225 min, respectively), as was the hospital discharge time (8.18 days and 11.63 days, respectively; p = 0.004). In both LRC groups, median blood loss was lower, compared with corresponding ORC groups (325 mL and 400 ml vs 800 mL and 1,100 mL, respectively; p < 0.001 in both cases). The level of complications was significantly lower in both LRC groups than in the ORC groups (p < 0.001 and p = 0.001, respectively). The lymph node yield was 12 in the LRC group and 10 in the ORC group. The LRC group had a lower positive surgical margins ratio.
Conclusion. The laparoscopic approach should be a valid option for radical cystectomy, given the fewer complications, smaller blood loss, and shorter operating and hospitalization times experienced by patients who underwent a laparoscopic cystectomy.

Key words

laparoscopy, cystectomy, urinary bladder neoplasms, cystectomy methods

References (27)

  1. Ferlay J, Steliarova-Foucher E, Lortet-Tieulent J, et al. Cancer incidence and mortality patterns in Europe: Estimates for 40 countries in 2012. Eur J Cancer. 2013;49(6):1374–1403.
  2. Babjuk M, Burger M, Zigeuner R, et al; European Association of Urology. EAU guidelines on non-muscle invasive urothelial carcinoma of the bladder: Update 2013. Eur Urol. 2017;71(3):447–461.
  3. Grossman HB, Natale RB, Tangen CM, et al. Neoadjuvant chemotherapy plus cystectomy compared with cystectomy alone for locally advanced bladder cancer. N Engl J Med. 2003;349(9):859–866.
  4. Cookson MS, Chang SS, Wells N, Parekh DJ, Smith JA Jr. Complications of radical cystectomy for nonmuscle invasive disease: Comparison with muscle invasive disease. J Urol. 2003;169(1):101–104.
  5. Boström PJ, Kössi J, Laato M, Nurmi M. Risk factors for mortality and morbidity related to radical cystectomy. BJU Int. 2009;103(2):191–196.
  6. Lowrance WT, Rumohr JA, Chang SS, Clark PE, Smith JA Jr, Cookson MS. Contemporary open radical cystectomy: Analysis of perioperative outcomes. J Urol. 2008;179(4):1313–1318.
  7. de Badajoz S, Perales G, Rosado RA, de la Cruz GJM, Garrido JA. Radical cystectomy and laparoscopic ileal conduit [in Spanish]. Arch Esp Urol. 1993;46(7):621–624.
  8. Guillotreau J, Gamé X, Mouzin M, et al. Radical cystectomy for bladder cancer: Morbidity of laparoscopic versus open surgery. J Urol. 2009;2(181):554–559.
  9. Menon M, Hemal AK, Tewari A, Shrivastava A, Shoma AM. Nerve-sparing robot-assisted radical cystoprostatectomy and urinary diversion. BJU Int. 2003;92(3):232–236.
  10. Xia L, Wang X, Xu T, et al. Robotic versus open radical cystectomy: An updated systematic review and meta-analysis. PLoS One. 2015;10(3):e0121032.
  11. Albisinni S, Rassweiler J, Abbou CC, et al. 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. BJU Int. 2015;115(6):937–945.
  12. Wein A. Campbell–Walsh Urology. 10th ed. Philadelphia, PA: Elsevier Saunders; 2012:2379–2408.
  13. Kondrup J, Rasmussen HH, Hamberg O, Stanga Z; Ad Hoc ESPEN Working Group. Nutritional risk screening (NRS 2002): A new method based on an analysis of controlled clinical trials. Clin Nutr. 2003;22(3):321–336.
  14. Sobin LH, Wittekind C. TNM Classification of Malignant Tumours. 6th ed. New York, NY: Wiley–Blackwell; 2002:23–25.
  15. Froehner M, Brausi MA, Herr HW, Muto G, Studer UE. Complications following radical cystectomy for bladder cancer in the elderly. Eur Urol. 2009;56(3):443–454.
  16. Clavien PA, Barkun J, de Oliviera ML, et al. The Clavien–Dindo classification of surgical complications: Five-year experience. Ann Surg. 2009;250(2):187–196.
  17. Hemal AK, Kolla SB. Comparison of laparoscopic and open radical cystoprostatectomy for localized bladder cancer with 3-year oncological follow-up: A single surgeon experience. J Urol. 2007;178(6):2340–2343.
  18. Huang J, Huang H, Lin TX, et al. Compare of laparoscopic and open surgery for radical cystectomy with orthotopic ileal neobladder [in Chinese]. Zhonghua Wai Ke Za Zhi. 2008;46(24):1870–1874.
  19. Porpiglia F, Renard J, Billia M, et al. Open versus laparoscopy-assisted radical cystectomy: Results of a prospective study. J Endourol. 2007;21(3):325–329.
  20. Tang K, Li H, Xia D, et al. Laparoscopic versus open radical cystectomy in bladder cancer: A systematic review and meta-analysis of comparative studies. PLoS One. 2014;16:9(5):e95667.
  21. Hautmann RE. The oncologic results of laparoscopic radical cystectomy are not (yet) equivalent to open cystectomy. Curr Opin Urol. 2009;19(5):522–526.
  22. Herr H, Lee C, Chang S, Lerner S; Bladder Cancer Collaborative Group. Standardization of radical cystectomy and pelvic lymph node dissection for bladder cancer: A collaborative group report. J Urol. 2004;171(5):1823–1828.
  23. Abboudi H, Khan MS, Guru KA, et al. Learning curves for urological procedures: A systematic review. BJU Int. 2014;114(4):617–629.
  24. Abraham JB, Young JL, Box GN, Lee HJ, Deane LA, Ornstein DK. Comparative analysis of laparoscopic and robot-assisted radical cystectomy with ileal conduit urinary diversion. J Endourol. 2007;21(12):1473–1480.
  25. Ha US, Kim SI, Kim SJ, Cho HJ, Hong SH. Laparoscopic versus open radical cystectomy for the management of bladder cancer: Mid-term oncological outcome. Int J Urol. 2010;17(1):55–61.
  26. Haber G-P, Crouzet S, Gill IS. Laparoscopic and robotic assisted radical cystectomy for bladder cancer: A critical analysis. Eur Urol. 2008;54(1):54–64.
  27. Lawrentschuk N, Colombo R, Hakenberg OW, et al. Prevention and management of complications following radical cystectomy for bladder cancer. Eur Urol. 2010;57(6):983–1001.