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

Abstract

BACKGROUND: Radical cystectomy (RC) is one of the most complex surgeries and has a high rate of morbidity. Gastrointestinal complications are the most common type of complications. To reduce these complications some modifications have been described. OBJECTIVE: To evaluate perioperative outcomes of our extraperitoneal antegrade RC technique (EARTC), where the peritoneum is opened at the end of cystectomy just before of ileal reconstruction. METHODS: Group 1 included 120 patients who were operated with a standard RC technique and Group 2 included 80 patients who were operated with the EARC technique in this study. Groups were compared according to preoperative variables including patient characteristics, perioperative parameters, pathologic data, and postoperative overall and gastrointestinal complications. RESULTS: There were no significant differences between the two groups in terms of preoperative characteristics and mean operative time. The group 1 has longer time for the exposure of abdominal cavity to the atmosphere (p < 0.01). Hospitalization time was significantly lower in Group 2 (p < 0.01). Concerning the rate of 90-day overall perioperative complication, no statistically significant difference was determined between the groups. Gastrointestinal complication was significantly higher in Group 1 (p:0.048). The average number of removed lymph nodes was similar between the groups (p:0.85). The time for recovery of bowel function, the time for passage of stool and the rate of postoperative ileus were significantly lower in Group 2 (p < 0.01, p < 0.01 and p < 0.043) respectively). CONCLUSIONS: EARC provides advantages over the standard technique in terms of gastrointestinal symptoms and poses no disadvantage when the oncological outcome and operative difficulty were considered.

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

“…The reason for this may be due to differences in laparoscopy or open method used in the operation, differences in surgeon’s performance experience, and also different availability of time-saving equipment such as endo-staplers for gut anastomosis, as well as thrombotic products like flowseal, hemolocks, ligaclips, ligasures, etc [ 15 ]. Many other authors conclude similarly [ 5 , 13 , 16 ]. However, against the trend, one of the studies associates TPRC with significant reduction in blood loss [ 9 ].…”

“…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 – 14 ].…”

“…Kulkarni, et al have also agreed that GI complications (ileus p < 0.001 and intestinal obstruction p = 0.002) are significantly lower in EPRC group [ 8 ]. Özkaptan, et al stated that the time for recovery of bowel function, the time for passage of stool, and the rate of postoperative ileus were significantly lower in EPRC group (p < 0.01, p < 0.01 and p < 0.043) respectively) [ 5 ]. 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 ].…”

“…The most common complication categories are gastrointestinal (29%), infectious (25%), and wound-related (15%), respectively. Ileus is the most common type of gastrointestinal complication (GC) [ 5 ].…”