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

Adamczyk, Przemysław; Juszczak, Kajetan; Kadłubowski, Mateusz; Ostrowski, Adam; Maciukiewicz, Piotr; Drewa, Tomasz

doi:10.17219/acem/115084

Cited by 7 publications

(7 citation statements)

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“…The median lymph node number of initial procedures was significantly lower compared to contemporary cases (9 vs. 15.5 for years 2016 and 2020, respectively; p = 0.0065), hence the lower median nodal yield of LRC is likely to represent a learning curve phenomenon [ 18 ]. The median lymph node count of our laparoscopic cohort is comparable to other early LRC series [ 19 , 20 , 21 ]. Interestingly, our ORC group had higher nodal yield than most published Polish studies comparing laparoscopic and conventional approaches to RC [ 20 ].…”

Section: Discussionsupporting

confidence: 76%

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The Influence of Lymph Node Count on Oncological Outcome of Radical Cystectomy in Chemotherapy Pre-Treated and Chemotherapy-Naïve Patients with Muscle Invasive Bladder Cancer

Lemiński

Kaczmarek

Michalski

et al. 2021

JCM

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Radical cystectomy (RC) with pelvic lymph node dissection (PLND) remains the mainstay of treatment for muscle-invasive bladder cancer (MIBC). The extent of PLND and number of removed lymph nodes (LNs) have been associated with improved staging and survival outcomes in several series of RC patients. Neoadjuvant chemotherapy (NAC) has become standard of care for cisplatin-eligible patients qualified to RC, yet few studies on PLND stratified cases according to the receipt of NAC. We aimed to address this issue and reevaluate the prognostic value of PLND nodal yields in series of patients who underwent RC on the verge of the NAC era. This single-center, retrospective, clinical follow-up study enrolled 439 consecutive patients, out of whom 83 received NAC. We analyzed survival outcome of RC according to the number of removed nodes between NAC and non-NAC subgroups. We found PLND thresholds of 10 and 15 LNs prognostically meaningful in our study cohort, and this association was particularly pronounced in the non-NAC subgroup. Higher numbers of LNs provided a 25% reduction in risk of all-cause mortality and correspondingly correlated with up to a 14% increase in 3-year overall survival. The receipt of NAC diminished the benefit of adequate PLND, as the number of retrieved LNs was not associated with survival in the NAC-RC cohort. Given the limitations of our study, additional research is needed to verify these findings.

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Section: Discussionsupporting

confidence: 76%

“…The median lymph node count of our laparoscopic cohort is comparable to other early LRC series [ 19 , 20 , 21 ]. Interestingly, our ORC group had higher nodal yield than most published Polish studies comparing laparoscopic and conventional approaches to RC [ 20 ].…”

Section: Discussionsupporting

confidence: 76%

The Influence of Lymph Node Count on Oncological Outcome of Radical Cystectomy in Chemotherapy Pre-Treated and Chemotherapy-Naïve Patients with Muscle Invasive Bladder Cancer

Lemiński

Kaczmarek

Michalski

et al. 2021

JCM

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“…We admit such surgical times would be difficult to achieve in local departments, but they are possible when performed in specialized centers by experienced surgeons. Moreover, as described in our previous studies, LRC and RARC are not significantly longer than ORC if the same type of urinary diversion is performed [28].…”

Section: Discussionmentioning

confidence: 57%

“…We found the number and severity of complications increased as the BMI increased in patients who underwent ORC; however, the opposite trend was observed in those who underwent LRC or RARC. Indeed, we previously found the BMI had no impact on blood loss following LRC [28], likely due to increased visualization of the anatomic structures compared to ORC. As perioperative blood transfusion increases the risk of morbidity, cancer recurrence, and mortality after RC [29], we propose that using a minimally invasive method in overweight/obese patients would be beneficial for minimizing blood loss during surgery and thus improving long-term outcomes.…”

Section: Discussionmentioning

confidence: 99%

Complication Rate after Radical Cystectomy Depends on the Surgical Technique and Patient’s Clinical Status

Adamczyk¹,

Pobłocki²,

Kadłubowski³

et al. 2021

Urol Int

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Purpose: This study aimed to explore the complication rates of radical cystectomy in patients with muscle-invasive bladder cancer and identify potential risk factors. Methods: A total of 553 patients were included: 131 were operated on via an open approach (ORC), 242 patients via a laparoscopic method (LRC), and 180 by a robot-assisted procedure (RARC). Patient age, gender, American Society of Anesthesiologists (ASA) score, urinary diversion type, preoperative albumin level, body mass index (BMI), pathological (TNM) stage, and surgical times were collected. The severity of complications was classified according to the Clavien-Dindo scale (Grades 1–5). Results: The surgical technique was significantly related to the number of complications (p < 0.00005). Grade 1 complications were observed most frequently following LRC (52.5%) and RARC (51.1%), whereas mostly Grade 2 complications were detected after ORC (78.6%). Those with less severe complications had significantly higher albumin levels than those with more severe complications (p < 0.05). Patients with an elevated BMI had fewer complications if a minimally invasive approach was used rather than ORC. The patient’s general condition (ASA score) did not impact the number of complications, and urinary diversion type did not affect the severity of the complications. Mean surgical time differed according to the urinary diversion type in patients with a similar TNM stage (p < 0.005); however, no difference was found in those with more locally advanced disease. Longer operation time and lower protein concentration were associated with higher probability of complication rate, that is, Clavien-Dindo score 3–5. Conclusions: The risk of complications after RC is not related to the type of urinary diversion, and can be reduced by using a minimally invasive surgical technique, especially in patients with high BMI.

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“…Adamczyk et al [ 53 ] analyzed 260 patients who underwent either laparoscopic or open radical cystectomy. The laparoscopic approach was superior in terms of median operating time and estimated blood loss.…”

Section: Discussionmentioning

confidence: 99%

Role of the Laparoscopic Approach for Complex Urologic Surgery in the Era of Robotics

Andraș

Territo

Telecan³

et al. 2021

JCM

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(1) Introduction: The advent of robotic surgery led to the assumption that laparoscopic surgery would be replaced entirely. However, the high costs of robotic surgery limit its availability. The aim of the current study was to assess the feasibility of the 3D laparoscopic approach for the most complex urological procedures. (2) Materials and methods: We included in the current study all patients who had undergone complex 3D laparoscopic procedures in our department since January 2017, including radical nephrectomy (LRN) using a dual combined approach (19 patients), radical nephroureterectomy (LRNU) with bladder cuff excision (13 patients), and radical cystectomy (LRC) with intracorporeal urinary diversion (ICUD) (21 patients). (3) Results: The mean operative time was 345/230/478 min, the complications rate was 26%/30.76%/23.8% and positive surgical margins were encountered in 3/1/1 patients for the combined approach of LRN/LRNU/LRC with ICUD, respectively. A single patient was converted to open surgery during LRN due to extension of the vena cava thrombus above the hepatic veins. After LRC, sepsis was the most common complication and 8 patients were readmitted at a mean of 15.5 days after discharge. (4) Conclusions: In the era of robotic surgery, laparoscopy remains a plausible alternative for most complex oncological cases.

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

Cited by 7 publications

References 0 publications

The Influence of Lymph Node Count on Oncological Outcome of Radical Cystectomy in Chemotherapy Pre-Treated and Chemotherapy-Naïve Patients with Muscle Invasive Bladder Cancer

The Influence of Lymph Node Count on Oncological Outcome of Radical Cystectomy in Chemotherapy Pre-Treated and Chemotherapy-Naïve Patients with Muscle Invasive Bladder Cancer

Complication Rate after Radical Cystectomy Depends on the Surgical Technique and Patient’s Clinical Status

Role of the Laparoscopic Approach for Complex Urologic Surgery in the Era of Robotics

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