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WJOL S
WJOLS

10.5005/jp-journals-10033-1272
Comparison of Open and Laparoscopic Radical Cystectomy for Bladder Cancer: Safety and Early Oncological Results
OriginaL articLe

Comparison of Open and Laparoscopic Radical

Cystectomy for Bladder Cancer: Safety and Early
Oncological Results

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1 Reva Sergey, Nosov Alexander, Djalilov Imran, Petrov Sergey
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ABSTRACT LOS compared with ORC. Using a population-based cohort,
we have found that laparoscopic surgery for bladder cancer
Objectives: To evaluate perioperative and postoperative reduced minor complications (mainly due to lower bleeding
morbidity and functional results of laparoscopic radical and gastrointestinal complication rate) and had no impact on
cystectomy (LRC) in a single-site cohort of patients by major complications.
comparing it with standard open radical cystectomy (ORC).
Keywords: Bladder cancer, Complications, Ileal neobladder,
Materials and methods: A prospective analysis was per- Radical cystectomy.
formed in 42 muscle invasive and locally advanced bladder
cancer (BCa) patients who underwent radical cystectomy How to cite this article: Sergey R, Alexander N, Imran D,
(RC) between February 2012 and March 2014 in N.N. Petrov Sergey P. Comparison of Open and Laparoscopic Radical
Research Institute of Oncology, Saint Petersburg, Russia. Cystectomy for Bladder Cancer: Safety and Early Oncological
The final cohort included 21 ORC and 21 LRC patients. The Results. World J Lap Surg 2016;9(2):51-57.
average patients’ age was 64 (38 to 81) years, which did not
differ between the groups. The pathological stage was similar Source of support: Nil
in the LRC and ORC groups. Multivariable logistic and median Conflict of interest: None
regression was performed to evaluate the operating time,
perioperative, and postoperative complications (30-day and
90-day) according to Clavien classification, readmission rates, INTRODUCTION
and length of stay (LOS) – both totally and in ICU.
Despite significant improvements in perioperative
Results: The operating time during LRC was longer than complications during last decades, radical cystectomy
that of ORC (398 vs 243 minutes respectively). Despite that, (RC) in patients with bladder cancer (BCa) is thought to be
there was no statistically significant influence of the type of
surgery on intraoperative complications – 14.3% in the ORC a major operative procedure with potential for substantial
group and 4.7% in the LRC patients. The major complication morbidity and mortality. 1,2
rates (Clavien grade ≥ 3; 23.8 vs 19.4%) were similar between Due to a widespread use of the laparoscopic tech-
the groups. However, LRC had four times lower rate of minor
complications (Clavien grade 1 and 2) compared to ORC nique, minimally invasive RC and intestinal urinary
(4.7 vs 19.0%). Laparoscopic radical cystectomy had a sig- reconstruction is becoming more and more common.
nificantly shorter LOS (27.8 vs 22.6 days in the ORC and LRC This technique has some benefits in terms of duration
groups respectively), but no significant differences in ICU stay of hospitalization with probably reduced morbidity of
existed (5.1 vs 2.1 days). Morbidity was presented by one patient 3-5
in each group (average rate 5.8%). The common transfusion the procedure. Among these techniques, laparoscopic
rate during and after surgical intervention was 19.6% and was radical cystectomy (LRC) has been demonstrated to be
higher in the ORC group (33.3 vs 4.7% in LRC); additionally, feasible, safe, and provides operative and functional
intraoperative bleeding was lower after laparoscopic cystectomy advantages. Besides, minimally invasive approach could
– the average volume of blood loss was 285 mL in LRC and
577 mL during ORC. Depending on the timing of complications, increase the number of patients eligible for adjuvant
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there were 30-day complications in 19 patients (37.2%) and chemotherapy. Despite that, technical difficulties and
90 days in 27 patients (52.9%). The greatest difference was high cost of the procedure have hampered its widespread
observed between the grades of gastrointestinal complications adoption. Recently, Smith et al have showed that only
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(foremost, ileus) with significantly better outcomes in the LRC
patients – 14.2% compared to 47.6% in ORC. 3% of surgeons performed purely intracorporeal urinary
diversion. Moreover, despite significant improvement in
Conclusion: We have found that LRC is safe and associated
with lower blood loss, reduced postoperative ileus, and lower mortality rates (from 2.4–15.0% in early series to 0–3.9% in
recent reports), early complication rates were not reduced
noticeably and still remain as high as 11 to 68%. 8
1,3 Oncologist-urologist, Chief, Scientist In this study, we report the results of treatment of
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1-4 Department of Oncourology, N.N. Petrov Research Institute patients with BCa in terms of safety (30-day and 90-day
of Oncology, Saint Petersburg, Russian Federation complication rate) and immediate oncological results after
Corresponding Author: Reva Sergery, Professor, Department LRC with complete intracorporeal ileal urinary diversion
of Oncourology, N.N. Petrov Research Institute of Oncology in 21 patients, by comparing them with the similar number
Saint Petersburg, Russian Federation, e-mail: sgreva79@mail.ru
of patients treated with open radical cystectomy (ORC).
World Journal of Laparoscopic Surgery, May-August 2016;9(2):51-57 51