Is Pure Laparoscopic Radical Cystectomy Still an Attractive Solution for the Treatment of Muscle-Invasive Bladder Cancer?

Abstract

Objective: The aim of this study is to report our experience with laparoscopic radical cystectomy (LRC), evaluating the technique and perioperative and pathological outcomes. Methods: 47 LRCs were performed due to muscle-invasive bladder cancer. Conduits were performed in 23 patients and neobladders in 23 (one bi-intestinal). One ureterocutaneostomy was created. Results: In 43 patients LRC was performed with minilaparotomy for urinary diversion. The mean operation time was 290 min. Four operations were converted. Complications included sigmoid colon injury, urinary leak, lymphatic leak, short-term paralytic ileus, and heart attack. Mean blood loss was 220 ml. Hospitalization time was 6 days. Tumor stage was pT2b, pT3a, pT3b, and pT4a in 28, 13, 5, and 1 patient, respectively. No positive margins were found. The mean number of lymph nodules was 17, while in the last 25 procedures it was 21. 17% of patients had tumor in the lymph nodes. The mean follow-up was 10 months. Local recurrence and dissemination was observed in 2%. Continence in patients receiving neobladder was fully satisfactory. Conclusions: More complications are related to neobladder than to ileac conduit. LRC with minilaparotomy seems to be an attractive treatment option for patients with muscle-invasive bladder cancer. Radical cystectomy performed intracorporeally could be reserved for ‘robot-assisted’ operations.

Robotic or Open Radical Cystectomy, Which Is Safer? A Systematic Review and Meta-Analysis of Comparative Studies

“…9 Despite these limitations, this approach has been shown to be safe and effective in experienced hands. [10][11][12][13] Robotic surgery has recently gained popularity, threatening to replace select open and laparoscopic procedures. The purported advantages of robotic surgery over laparoscopic surgery are increased maneuverability, improved vision with ten times magnification, enhanced endo-wrist dexterity, tremor elimination, and a shorter learning curve.…”

Bladder cancer – the neglected tumor: a descriptive analysis of publications referenced in MEDLINE and data from the register clinicaltrials.gov

“…There have also been no fundamental changes in the performance of artificial urinary diversion in the last decade. Regarding the development of new surgical techniques for advanced bladder cancer, this tumor is clearly overshadowed by the implementation of new surgical treatments for kidney and prostate cancer (i.e., open versus laparoscopic versus robotic approaches) [20,21]. Overall, the pharmaceutical and equipment manufacture markets revolve around prostate and kidney neoplasms almost exclusively (i.e., for medical tumor therapy, androgen suppression therapy, and surgical techniques).…”

Radical cystectomy – pro laparoscopic

“…In der Zwischenzeit liegen weltweit mittelfristige Ergebnisse von über 1000 Patienten vor [31,32]. Ein Großteil dieser Daten (n=517) wurde im Rahmen einer internationalen Studie erfasst [24].…”