Transperitoneal vs. extraperitoneal radical cystectomy for bladder cancer: A retrospective study

Abstract

PurposeConventional transperitoneal radical cystectomy (TPRC) is the standard approach for muscle invasive bladder cancer. But, the procedure is associated with significant morbidities like urinary leak, ileus, and infection. To reduce these morbidities, the technique of extraperitoneal radical cystectomy (EPRC) was described by us in 1999. We compared these two approaches and the data accrued forms the basis of this report.Materials and MethodsAll patients who underwent radical cystectomy for bladder cancer by the author (JNK) with follow-up for at least 5 years were included. A total of 338 patients were studied, with 180 patients in EPRC group and 158 in TPRC group.ResultsThere were 3 mortalities within 30 days in TPRC group and one in EPRC group. Early complication rate was 52% and 58% in EPRC and TPRC groups. Urinary leak occurred in 31 (9.2%) patients (13 in EPRC, 18 in TPRC, p=0.19). Gastrointestinal complications like ileus occurred in 9 (5%) patients in EPRC group and in 25 (15.8%) patients in TPRC group, (p<0.001). Wound dehiscence occurred in 29, and 36 patients in EPRC and TPRC groups respectively. The reoperation rate was 6.1% and 12% in EPRC and TPRC groups, (p=0.08). Intestinal obstruction were significantly less in EPRC group (1.7% vs. 7.8% in TPRC group, p=0.002). Uretero-enteric anastomosis stricture was seen in 10 patients (4 in EPRC, 6 in TPRC, p=0.39).ConclusionsThe EPRC is associated with decrease gastrointestinal complications, ease of management of urinary leaks, and low reoperation rates. Thus EPRC appears safe functionally and oncologically.

Extraperitoneal Antegrade vs Transperitoneal Open Radical Cystectomy: Single Center Experiences with 200 Cases

“…Wound-related complications are one of the most frequent complications in RC [13]. Kulkarni concluded in their study that an infra-umbilical incision combined with the extraperitoneal RC technique led to lower wound-related complications [22]. In contrast to their study, our findings revealed no statistically significant difference according to wound-related complications.…”

“…We are able to operate on patients with locally advanced disease, seminal vesicle invasion and bulky tumors with this modified technique while Kulkarni et al excluded such patients from their study, where they preserved the posterior peritoneal layer [22]. The reason for this is most probably the risk of leaving positive tumor margins in such patients.…”

Extraperitoneal Laparoscopic Radical Cystectomy With Preservation of Fertility for the Treatment of Ewing Sarcoma: The First Report of a Reliable Surgical Method

“…In addition, it has been reported that the possibility of peritoneal involvement in T1-T2 bladder cancer patients is extremely low [33], which was also observed in this study. Thirdly, the peritoneum was opened by a small incision later and suture closure early, to minimize the operational stimulation and intestinal exposure to the atmosphere, thus early recovery of peristalsis reduced postoperative intestinal obstruction [34], as well as the rate of hernia formation. Finally, the artificial extraperitoneal cavity theoretically has appropriate pressure on the complete extraperitoneal orthotopic neobladder, which is conducive to the full drainage of urine and prevents the infinite expansion of the ileum in the long term.…”

A new ureteroileal anastomosis technique in modified ileal orthotopic bladder substitution after radical cystectomy

“…The extraperitoneal approach of radical cystectomy and ileal orthotopic substitution has been shown to result in less blood loss, fewer complications, and rapid recovery [21]. We adopted this approach in order to avoid disturbing the neobladder and anastomotic stoma by intraperitoneal organs.…”