Comparison of Laparoscopic and Open Radical Cystoprostatectomy for Localized Bladder Cancer With 3-Year Oncological Followup: A Single Surgeon Experience

Purpose

We compared the results of laparoscopic and open radical cystectomy performed for organ confined bladder cancer by a single surgeon.

Materials and Methods

Between June 1999 and December 2005, 55 laparoscopic radical cystectomies were performed by a single surgeon. Of these patients 30 who had organ confined bladder cancer on preoperative evaluation formed the laparoscopic radical cystectomy group and 35 who underwent open radical cystectomy performed by the same surgeon formed the open radical cystectomy group. All patients underwent radical cystectomy, pelvic lymphadenectomy and ileal conduit urinary diversion. In the laparoscopic radical cystectomy group the ileal conduit was created through the 6 to 10 cm midline incision used for specimen extraction.

Results

Mean operative time was significantly more in the laparoscopic group. However, mean blood loss, analgesic requirement and transfusion requirement were significantly less in the laparoscopic group. The complication rate in the 2 groups was not significantly different. One patient per group had a margin positive for bladder cancer. At a mean followup of 38 (range 15 to 54) and 46 months (range 14 to 96) 23 patients (76%) in the laparoscopic group and 28 (80%) in the open group, respectively, survived free of recurrence (p = 0.2).

Conclusions

The laparoscopic approach provides the benefit of lesser blood loss and postoperative pain in patients undergoing radical cystectomy for organ confined bladder cancer. The oncological outcome is comparable to that of open radical cystectomy at 3-year followup. However, longer followup in a larger cohort of patients is needed to assess long-term oncological and functional outcomes.

Key Words: bladder, urinary diversion, bladder neoplasms, laparoscopy, cystectomy

Abbreviations and Acronyms: ASA, American Society of Anesthesiologists, BMI, body mass index, Hb, hemoglobin, LRC, laparoscopic radical cystoprostatectomy, ORC, open radical cystoprostatectomy, POD, postoperative day