Skip to main content

Advertisement

SpringerLink
Log in

Extraperitoneal Versus Intraperitoneal Radical Cystectomy for Bladder Cancer: A Systematic Review and Meta-Analysis

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

This study aimed to compare perioperative and oncologic outcomes of extraperitoneal radical cystectomy (EPRC) and transperitoneal radical cystectomy (TPRC).

Methods

A systematical search of multiple scientific databases was performed in September 2022. The systematic review and cumulative meta-analysis of the primary outcomes of interest were performed according to the PRISMA and AMSTAR guidelines and registered in the PROSPERO database (PROSPERO [CRD42022359322]).

Results

The review and analysis included eight studies with 989 participants. No significant differences were found between EPRC and TPRC in terms of operation time, estimated blood loss (EBL), hospital length of stay (LOS), or transfusion. A shorter exhaust time (standardized mean difference [SMD] − 0.59; 95 % confidence interval [CI] − 0.97 to 0.21; p = 0.002) and time to liquid intake (SMD, − 0.56; 95 % CI − 1.07 to 0.04; p = 0.03) were associated with EPRC. No clinically meaningful difference was observed in terms of postoperative infection, wound complications, postoperative genitourinary complications, late postoperative complications, early major complications, or late major complications. However, EPRC was related to lower incidences of early postoperative complications (odds ratio [OR], 0.66; 95 % CI 0.51–0.86; p = 0.002), gastrointestinal complications (OR 0.28; 95 % CI 0 0.17–0.46; p < 0.00001), and postoperative ileus (OR 0.38; 95 % CI 0.25–0.59; p < 0.0001). A higher incidence of postoperative lymphocele was associated with EPRC (OR 3.05; 95 % CI 1.13–8.25; p = 0.03). No clinically meaningful difference was found in terms of positive surgical margin (PSM), local recurrence, distant metastasis, or OS.

Conclusions

Although EPRC had a higher incidence of lymphoceles than TPRC, it was found to have similar oncologic outcomes and fewer early complications, particularly in terms of postoperative gastrointestinal complications and ileus. These results suggest that EPRC is a safe option both functionally and oncologically.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71:209–49.

    Article  PubMed  Google Scholar 

  2. Babjuk M, Burger M, Capoun O, et al. European Association of Urology guidelines on non-muscle-invasive bladder cancer (Ta, T1, and carcinoma in situ). Eur Urol. 2022;81:75–94.

    Article  PubMed  Google Scholar 

  3. Witjes JA, Bruins HM, Cathomas R, et al. European Association of Urology guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2020 guidelines. Eur Urol. 2021;79:82–104.

    Article  CAS  PubMed  Google Scholar 

  4. Shabsigh A, Korets R, Vora KC, et al. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol. 2009;55:164–74.

    Article  PubMed  Google Scholar 

  5. Hu X, Xiong SC, Dou WC, et al. Minimally invasive vs open radical cystectomy in patients with bladder cancer: a systematic review and meta-analysis of randomized controlled trials. Eur J Surg Oncol. 2020;46:44–52.

    Article  PubMed  Google Scholar 

  6. Wijburg CJ, Michels CTJ, Hannink G, et al. Robot-assisted radical cystectomy versus open radical cystectomy in bladder cancer patients: a multicentre comparative effectiveness study. Eur Urol. 2021;79:609–18.

    Article  PubMed  Google Scholar 

  7. Varkarakis IM, Chrisofos M, Antoniou N, Papatsoris A, Deliveliotis C. Evaluation of findings during re-exploration for obstructive ileus after radical cystectomy and ileal-loop urinary diversion: insight into potential technical improvements. BJU Int. 2007;99:893–7.

    Article  PubMed  Google Scholar 

  8. Kulkarni JN, Gulla RI, Tongaonkar HB, Kashyapi BD, Rajyaguru KB. Radical cystoprostatectomy: an extraperitoneal retrograde approach. J Urol. 1999;161:545–8.

    Article  CAS  PubMed  Google Scholar 

  9. De Nunzio C, Cicione A, Leonardo F, et al. Extraperitoneal radical cystectomy and ureterocutaneostomy in octogenarians. Int Urol Nephrol. 2011;43:663–7.

    Article  PubMed  Google Scholar 

  10. Serel TA, Sevin G, Perk H, Kosar A, Soyupek S. Antegrade extraperitoneal approach to radical cystectomy and ileal neobladder. Int J Urol. 2003;10:25–8.

    Article  PubMed  Google Scholar 

  11. Zhu G, Zhang Z, Zhao K, et al. Laparoscopic radical cystectomy with pelvic lymph node dissection and ileal orthotopic neobladder by a total extraperitoneal approach: our initial technique and short-term outcomes. Investig Clin Urol. 2022;63:523–30.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kulkarni JN, Agarwal H. Transperitoneal vs extraperitoneal radical cystectomy for bladder cancer: a retrospective study. Int Braz J Urol. 2018;44:296–303.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. Int J Surg London, England. 2021;88:105906.

    Article  Google Scholar 

  14. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Tang K, Li H, Xia D, et al. Laparoscopic versus open radical cystectomy in bladder cancer: a systematic review and meta-analysis of comparative studies. PLoS One. 2014;9:e95667.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Sterne JAC, Hernán MA, Reeves BC, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ. 2016;55:4919.

    Article  Google Scholar 

  17. Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336:924–6.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Feng L, Song J, Wu M, Tian Y, Zhang D. Extraperitoneal versus transperitoneal laparoscopic radical cystectomy for selected elderly bladder cancer patients: a single-center experience. Int Braz J Urol. 2016;42:655–62.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Jentzmik F, Schostak M, Stephan C, et al. Extraperitoneal radical cystectomy with extraperitonealization of the ileal neobladder: a comparison to the transperitoneal technique. World J Urol. 2010;28:457–63.

    Article  PubMed  Google Scholar 

  20. Park DS, Gong IH, Choi DK, Hwang JH, Kang MH, Oh JJ. A feasibility study of peritoneum preservation in radical cystectomy with extraperitonealization of orthotopic neobladder for invasive high-grade bladder cancer: a preliminary analysis. Int Urol Nephrol. 2014;46:1107–13.

    Article  PubMed  Google Scholar 

  21. Refaai K, Sharafeldin MA, Elabbady A, et al. Perioperative outcomes of open retrograde extraperitoneal versus intracorporeal robot-assisted radical cystoprostatectomy in men: a dual-center comparative study. Clin Genitourin Cancer. 2020;18:e315–23.

    Article  PubMed  Google Scholar 

  22. Soleimani M, Moradkhani E, Masoumi N, Gholivandan J. Extra-peritoneal versus trans-peritoneal open radical cystectomy: comparison of two techniques in early post-operative complications. Urol J. 2020;18:519–24.

    Google Scholar 

  23. Zhang Y, Zhou H, Tuo ZT, Wang J, Sun C, Bi L. Extraperitoneal laparoscopic radical cystectomy with intracorporeal neobladder: a comparison with transperitoneal approach. World J Surg Oncol. 2022;20:130.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Zhao J, Zeng S, Zhang Z, et al. Laparoscopic radical cystectomy versus extraperitoneal radical cystectomy: is the extraperitoneal technique rewarding? Clin Genitourin Cancer. 2015;13:e271–7.

    Article  PubMed  Google Scholar 

  25. Hollenbeck BK, Miller DC, Taub D, et al. Identifying risk factors for potentially avoidable complications following radical cystectomy. J Urol. 2005;174(4 Pt 1):1231–7.

    Article  PubMed  Google Scholar 

  26. Novotny V, Hakenberg OW, Wiessner D, et al. Perioperative complications of radical cystectomy in a contemporary series. Eur Urol. 2007;51:397–401.

    Article  PubMed  Google Scholar 

  27. Roth B, Birkhauser FD, Zehnder P, Burkhard FC, Thalmann GN, Studer UE. Readaptation of the peritoneum following extended pelvic lymphadenectomy and cystectomy has a significant beneficial impact on early postoperative recovery and complications: results of a prospective randomized trial. Eur Urol. 2011;59:204–10.

    Article  PubMed  Google Scholar 

  28. Vartolomei MD, Kiss B, Vidal A, Burkhard F, Thalmann GN, Roth B. Long-term results of a prospective randomized trial assessing the impact of re-adaptation of the dorsolateral peritoneal layer after extended pelvic lymph node dissection and cystectomy. BJU Int. 2016;117:618–28.

    Article  PubMed  Google Scholar 

  29. Iwata T, Kobayashi Y, Maruyama Y, et al. Comparison of intracorporeal versus extracorporeal urinary diversion after robot-assisted radical cystectomy at a medium-sized facility. Int J Clin Oncol. 2021;26:1714–21.

    Article  PubMed  Google Scholar 

  30. Linder BJ, Frank I, Cheville JC, et al. The impact of perioperative blood transfusion on cancer recurrence and survival following radical cystectomy. Eur Urol. 2013;63:839–45.

    Article  PubMed  Google Scholar 

  31. Novara G, De Marco V, Aragona M, et al. Complications and mortality after radical cystectomy for bladder transitional cell cancer. J Urol. 2009;182:914–21.

    Article  PubMed  Google Scholar 

  32. Mattei A, Birkhaeuser FD, Baermann C, Warncke SH, Studer UE. To stent or not to stent perioperatively the ureteroileal anastomosis of ileal orthotopic bladder substitutes and ileal conduits? Results of a prospective randomized trial. J Urol. 2008;179:582–6.

    Article  PubMed  Google Scholar 

  33. Zhu YP, Ye DW, Yao XD, et al. Defining good candidates for extraperitoneal cystectomy: results from random peritoneum biopsies of 136 cases. Urology. 2013;81:820–4.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This work was supported by the National Natural Science Foundation of China (No. 82160148) and the Second Hospital of Lanzhou University, Cuiying Science and Technology Innovation" Program (No. CY2022-QN-B04).

Author information

Authors and Affiliations

  1. Department of Urology, Second Hospital of Lanzhou University, Lanzhou, Gansu, China

    Chengyu You MD, Qingchao Li MD, Yongjin Yang MD, Liangliang Qing MD, Shuai Liu MD, Yanan Wang MD & Zhilong Dong MD

Authors
  1. Chengyu You MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Qingchao Li MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yongjin Yang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Liangliang Qing MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Shuai Liu MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yanan Wang MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Zhilong Dong MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Zhilong Dong MD.

Ethics declarations

Disclosure

There are no conflicts of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

You, C., Li, Q., Yang, Y. et al. Extraperitoneal Versus Intraperitoneal Radical Cystectomy for Bladder Cancer: A Systematic Review and Meta-Analysis. Ann Surg Oncol 30, 5932–5941 (2023). https://doi.org/10.1245/s10434-023-13744-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-023-13744-5

Search

Navigation