Skip to main content

Advertisement

SpringerLink
Log in

Long-term evaluation of oncologic and functional outcomes after laparoscopic open-assisted radical cystectomy: a matched-pair analysis

  • Original Article
  • Published:
World Journal of Urology Aims and scope Submit manuscript

Abstract

Purpose

To evaluate peri- and postoperative morbidity, and long-term oncologic and functional results of our laparoscopic radical cystectomy (LRC) technique, comparing it with our standard open approach.

Methods

Between 2000 and 2010, 54 patients underwent LRC for urothelial cell carcinoma of the bladder in two academic hospitals. The procedures were performed by two surgeons. Patients were matched 1:1 with patients who underwent open RC in the same years by the same surgical team. Differences in peri- and postoperative complications across the two groups were assessed using Wilcoxon’s rank-sum or χ 2 test. Kaplan–Meier curves, log-rank tests and Cox regression models were constructed to assess differences in recurrence-free survival on long-term follow-up between the two groups.

Results

Laparoscopic radical cystectomy was significantly associated with lower blood loss (p < 0.0001) and less frequent postoperative ileus (p = 0.03). Regarding more serious postoperative complications, no difference was found across the two cohorts. Median oncologic follow-up was 42 months (IQR 12–72 months) in the LRC cohort and 18 months (IQR 8–27 months) in patients undergoing open radical cystectomy (ORC). No statistically significant difference in recurrence-free survival was observed between the two groups (log rank p = 0.677). On univariate Cox regression, the surgical approach used was not significantly associated with risk of recurrence.

Conclusions

We found that LRC is safe and associated with lower blood loss and decreased postoperative ileus compared with ORC. Moreover, on long-term oncologic follow-up, LRC appeared non-inferior to ORC with no significant difference in recurrence-free survival. Nonetheless, these results must be confirmed by larger series and stronger long-term follow-up data are needed.

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

Similar content being viewed by others

References

  1. Gakis G, Efstathiou J, Lerner SP, Cookson MS, Keegan KA, Guru KA, Shipley WU, Heidenreich A, Schoenberg MP, Sagaloswky AI, Soloway MS, Stenzl A (2013) ICUD-EAU international consultation on bladder cancer 2012: radical cystectomy and bladder preservation for muscle-invasive urothelial carcinoma of the bladder. Eur Urol 63(1):45–57. doi:10.1016/j.eururo.2012.08.009

    Article  PubMed  Google Scholar 

  2. Lowrance WT, Rumohr JA, Chang SS, Clark PE, Smith JA Jr, Cookson MS (2008) Contemporary open radical cystectomy: analysis of perioperative outcomes. J Urol 179(4):1313–1318; discussion 1318. doi:10.1016/j.juro.2007.11.084

    Google Scholar 

  3. Pruthi RS, Wallen EM (2007) Robotic assisted laparoscopic radical cystoprostatectomy: operative and pathological outcomes. J Urol 178(3 Pt 1):814–818. doi:10.1016/j.juro.2007.05.040

    Article  PubMed  Google Scholar 

  4. Desai MM, Berger AK, Brandina RR, Zehnder P, Simmons M, Aron M, Skinner EC, Gill IS (2012) Robotic and laparoscopic high extended pelvic lymph node dissection during radical cystectomy: technique and outcomes. Eur Urol 61(2):350–355. doi:10.1016/j.eururo.2011.09.011

    Article  PubMed  Google Scholar 

  5. Styn NR, Montgomery JS, Wood DP, Hafez KS, Lee CT, Tallman C, He C, Crossley H, Hollenbeck BK, Weizer AZ (2012) Matched comparison of robotic-assisted and open radical cystectomy. Urology 79(6):1303–1308. doi:10.1016/j.urology.2012.01.055

    Article  PubMed  Google Scholar 

  6. Haber GP, Crouzet S, Gill IS (2008) Laparoscopic and robotic assisted radical cystectomy for bladder cancer: a critical analysis. Eur Urol 54(1):54–62. doi:10.1016/j.eururo.2008.03.076

    Article  PubMed  Google Scholar 

  7. Cathelineau X, Arroyo C, Rozet F, Barret E, Vallancien G (2005) Laparoscopic assisted radical cystectomy: the montsouris experience after 84 cases. Eur Urol 47(6):780–784. doi:10.1016/j.eururo.2005.04.001

    Article  PubMed  Google Scholar 

  8. Parekh DJ, Messer J, Fitzgerald J, Ercole B, Svatek R (2013) Perioperative outcomes and oncologic efficacy from a pilot prospective randomized clinical trial of open versus robotic assisted radical cystectomy. J Urol 189(2):474–479. doi:10.1016/j.juro.2012.09.077

    Article  PubMed  Google Scholar 

  9. Huang J, Lin T, Liu H, Xu K, Zhang C, Jiang C, Huang H, Yao Y, Guo Z, Xie W (2010) Laparoscopic radical cystectomy with orthotopic ileal neobladder for bladder cancer: oncologic results of 171 cases with a median 3-year follow-up. Eur Urol 58(3):442–449. doi:10.1016/j.eururo.2010.05.046

    Article  PubMed  Google Scholar 

  10. Hautmann RE (2009) The oncologic results of laparoscopic radical cystectomy are not (yet) equivalent to open cystectomy. Curr Opin Urol 19(5):522–526. doi:10.1097/MOU.0b013e32832d9564

    Article  PubMed  Google Scholar 

  11. Challacombe BJ, Bochner BH, Dasgupta P, Gill I, Guru K, Herr H, Mottrie A, Pruthi R, Redorta JP, Wiklund P (2011) The role of laparoscopic and robotic cystectomy in the management of muscle-invasive bladder cancer with special emphasis on cancer control and complications. Eur Urol 60(4):767–775. doi:10.1016/j.eururo.2011.05.012

    Article  PubMed  Google Scholar 

  12. Ng CK, Kauffman EC, Lee MM, Otto BJ, Portnoff A, Ehrlich JR, Schwartz MJ, Wang GJ, Scherr DS (2010) A comparison of postoperative complications in open versus robotic cystectomy. Eur Urol 57(2):274–281. doi:10.1016/j.eururo.2009.06.001

    Article  PubMed  Google Scholar 

  13. van Velthoven RF, Piechaud T (2005) Laparoscopic radical cystectomy with ileal conduit diversion. Curr Urol Rep 6(2):93–100

    Article  PubMed  Google Scholar 

  14. Van Velthoven R, Rassweiler J (2005) Laparoscopic radical cystectomy with orthotopic bladder replacement. In: De La Rosette J, Gill IS (eds) Laparoscopic urologic surgery in malignancies. Springer, Berlin, pp 97–113

    Chapter  Google Scholar 

  15. Van Velthoven RF, Ahlering TE, Peltier A, Skarecky DW, Clayman RV (2003) Technique for laparoscopic running urethrovesical anastomosis: the single knot method. Urology 61(4):699–702

    Article  PubMed  Google Scholar 

  16. Nix J, Smith A, Kurpad R, Nielsen ME, Wallen EM, Pruthi RS (2010) Prospective randomized controlled trial of robotic versus open radical cystectomy for bladder cancer: perioperative and pathologic results. Eur Urol 57(2):196–201. doi:10.1016/j.eururo.2009.10.024

    Article  PubMed  Google Scholar 

  17. Porpiglia F, Renard J, Billia M, Scoffone C, Cracco C, Terrone C, Scarpa RM (2007) Open versus laparoscopy-assisted radical cystectomy: results of a prospective study. J Endourol 21(3):325–329. doi:10.1089/end.2006.0224

    Article  PubMed  Google Scholar 

  18. Basillote JB, Abdelshehid C, Ahlering TE, Shanberg AM (2004) Laparoscopic assisted radical cystectomy with ileal neobladder: a comparison with the open approach. J Urol 172(2):489–493. doi:10.1097/01.ju.0000129662.83162.2e

    Article  PubMed  Google Scholar 

  19. Stenzl A, Cowan NC, De Santis M, Kuczyk MA, Merseburger AS, Ribal MJ, Sherif A, Witjes JA, European Association of U (2011) Treatment of muscle-invasive and metastatic bladder cancer: update of the EAU guidelines. Eur Urol 59(6):1009–1018. doi:10.1016/j.eururo.2011.03.023

    Article  CAS  PubMed  Google Scholar 

  20. Huang GJ, Stein JP (2007) Open radical cystectomy with lymphadenectomy remains the treatment of choice for invasive bladder cancer. Curr Opin Urol 17(5):369–375. doi:10.1097/MOU.0b013e3282dc95b5

    Article  PubMed  Google Scholar 

  21. Herr H, Lee C, Chang S, Lerner S, Bladder Cancer Collaborative G (2004) Standardization of radical cystectomy and pelvic lymph node dissection for bladder cancer: a collaborative group report. J Urol 171(5):1823–1828; discussion 1827–1828. doi:10.1097/01.ju.0000120289.78049.0e

  22. Hayn MH, Hussain A, Mansour AM, Andrews PE, Carpentier P, Castle E, Dasgupta P, Rimington P, Thomas R, Khan S, Kibel A, Kim H, Manoharan M, Menon M, Mottrie A, Ornstein D, Peabody J, Pruthi R, Palou Redorta J, Richstone L, Schanne F, Stricker H, Wiklund P, Chandrasekhar R, Wilding GE, Guru KA (2010) The learning curve of robot-assisted radical cystectomy: results from the international robotic cystectomy consortium. Eur Urol 58(2):197–202. doi:10.1016/j.eururo.2010.04.024

    Article  PubMed  Google Scholar 

  23. Richards KA, Hemal AK (2012) Anatomic robot-assisted radical cystectomy. J Endourol 26(12):1586–1595. doi:10.1089/end.2012.0398

    Article  PubMed  Google Scholar 

  24. Fedeli U, Novara G, Galassi C, Ficarra V, Schievano E, Gilardetti M, Muto G, Bertetto O, Ciccone G, Spolaore P (2011) Population-based analyses of radical cystectomy and urinary diversion for bladder cancer in northern Italy. BJU Int 108(8 Pt 2):E266–E271. doi:10.1111/j.1464-410X.2011.10095.x

    Article  PubMed  Google Scholar 

  25. Treiyer A, Saar M, Butow Z, Kamradt J, Siemer S, Stockle M (2012) Robotic-assisted laparoscopic radical cystectomy: surgical and oncological outcomes. Int Braz J Urol 38(3):324–329

    Article  PubMed  Google Scholar 

  26. Torrey RR, Chan KG, Yip W, Josephson DY, Lau CS, Ruel NH, Wilson TG (2012) Functional outcomes and complications in patients with bladder cancer undergoing robotic-assisted radical cystectomy with extracorporeal Indiana pouch continent cutaneous urinary diversion. Urology 79(5):1073–1078. doi:10.1016/j.urology.2011.12.050

    Article  PubMed  Google Scholar 

  27. Hautmann RE, Abol-Enein H, Davidsson T, Gudjonsson S, Hautmann SH, Holm HV, Lee CT, Liedberg F, Madersbacher S, Manoharan M, Mansson W, Mills RD, Penson DF, Skinner EC, Stein R, Studer UE, Thueroff JW, Turner WH, Volkmer BG, Xu A (2013) ICUD–EAU international consultation on bladder cancer 2012: urinary diversion. Eur Urol 63(1):67–80. doi:10.1016/j.eururo.2012.08.050

    Article  PubMed  Google Scholar 

  28. Huang J, Lin T, Xu K, Huang H, Jiang C, Han J, Yao Y, Guo Z, Xie W, Yin X, Zhang C (2008) Laparoscopic radical cystectomy with orthotopic ileal neobladder: a report of 85 cases. J Endourol 22(5):939–946. doi:10.1089/end.2007.0298

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, Jules Bordet Institute, Université Libre de Bruxelles, Boulevard de Waterloo 121, Brussels, Belgium

    Simone Albisinni, Ksenija Limani, Lisa Ingels, Felix Kwizera, Eric Hawaux, Alexandre Peltier & Roland van Velthoven

  2. Department of Urology, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium

    Simone Albisinni, Lisa Ingels, Renaud Bollens, Thierry Quackels, Marc Vanden Bossche & Thierry Roumeguère

Authors
  1. Simone Albisinni
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ksenija Limani
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lisa Ingels
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Felix Kwizera
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Renaud Bollens
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Eric Hawaux
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Thierry Quackels
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Marc Vanden Bossche
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Alexandre Peltier
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Thierry Roumeguère
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Roland van Velthoven
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Simone Albisinni.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Albisinni, S., Limani, K., Ingels, L. et al. Long-term evaluation of oncologic and functional outcomes after laparoscopic open-assisted radical cystectomy: a matched-pair analysis. World J Urol 32, 1455–1461 (2014). https://doi.org/10.1007/s00345-014-1245-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00345-014-1245-1

Keywords

Search

Navigation