Comparison of Extraperitoneal and Transperitoneal Radical Cystoprostatectomy in Terms of First 30 Days Outcomes

Abstract

Objective: To compare the first 30-day outcomes of Trans-peritoneal and Extra-peritoneal Radical cysto-prostatectomy.
 Study Design: Quasi-experimental study.
 Place and Duration of Study: Armed Forces Institute of Urology, Rawalpindi, from Mar 2015 to Mar 2019.Methodology: A total of 100 patients who underwent Radical cystoprostatectomy were observed in two groups either by extra or trans-peritoneal approach. Patients diagnosed with carcinoma urinary bladder (both muscle and non-muscle invasive) vetted through multidisciplinary meeting, with or without neo-adjuvant chemotherapy were included. Patients undergoing salvage cystectomy or any previous open abdomino-pelvic surgery were excluded. The standard techniques were used for both approaches. Variables under study were recorded for first 30-day-followup period.
 Results: The mean age was 59.9 ± 7.231 years (range=34-80). In extra-peritoneal group the mean duration of surgery was 5.6 ± 1.16 hours comparing to 7.2 ± 1.34 hours in the trans-peritoneal group. Statistically significant trend was also noted in the favour of extra-peritoneal group for stay in Intensive care in post-operative period (3.00 ± 1.19 days/4.77 ± 1.20, p<0.001) as well total stay in the hospital (6.06 ± 2.8 days/ 11.74 ± 4.17, p<0.001). Overall comparison of total number of complications as per Clavien-Dindo system in both groups was insignificant (p=0.136), however a significant trend in favour of extraperitoneal group was noted with respect to major wound dehiscence as well rate of blood transfusion (p<0.001).
 Conclusion: Extra-peritoneal approach showed a favourable trend in terms of operative time and early recovery after radical cysto-prostatectomy.

Transperitoneal vs extraperitoneal radical cystectomy: A systematic review and meta-analysis

“…Soleimani, et al claimed that early GI complications were lower in EPRC groups, including oral intake intolerance (21 vs. 8, p = 0.04), ileus (19 vs. 8, p = 0.04), intestinal obstruction (3 vs. 0, p = 0.04), and anastomosis leakage (8 vs. 1, p = 0.01) [12]. Several other studies also concluded similar results [13,14]. In this meta-analysis, we found no significant difference related to major complications occurring after EPRC or TPRC surgery.…”

“…Because of these multifactorial reasons that could alter the hospitalization time, is not out of the ordinary that high heterogeneity is found (I 2 = 96%) between the studies included. However, two authors have claimed that the duration of patient stay is significantly lower EPRC group [ 3 , 14 ]. Özkaptan et al and Soleimani et al, also concur that the mean length of hospital stay is shorter in the EPRC group, although not significant [ 5 , 12 ].…”

“…In this meta-analysis, we found no significant difference related to major complications occurring after EPRC or TPRC surgery. Along with this finding, none of the studies included in the analysis stated any significant differences between both groups [3,5,[12][13][14].…”