Is pure laparoscopic radical cystectomy still an attractive solution for the treatment of muscle-invasive bladder cancer?
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.
Chlosta
Piotr
P
Department of Urology, Institute of Oncology, Kielce, Poland.
Drewa
Tomasz
T
Dobruch
Jakub
J
Antoniewicz
Artur
A
Olejniczak
Pawel
P
Obarzanowski
Mateusz
M
Borowka
Andrzej
A
D000368:Aged; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006760:Hospitalization; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008495:Medical Oncology / Q000379:methods; D008875:Middle Aged; D009132:Muscles / Q000473:pathology; D009361:Neoplasm Invasiveness; D012008:Recurrence; D013514:Surgical Procedures, Operative; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000473:pathology; D001749:Urinary Bladder Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D014572:Urology / Q000379:methods