title: The role of laparoscopic and robotic cystectomy in the management of muscle-invasive bladder cancer with special emphasis on cancer control and complications.
abstract: BACKGROUND
  Minimally invasive radical cystectomy (MIRC) techniques for the treatment of muscle-invasive bladder cancer (BCa) are being increasingly applied. MIRC offers the potential benefits of a minimally invasive approach in terms of reduced blood loss and analgesic requirements whilst striving to provide similar oncologic efficacy to open radical cystectomy (ORC). Whether quicker recovery, shorter hospital stay, and a reduction in complications are routinely achieved with MIRC remains to be proved in prospective comparisons.
  
  
  OBJECTIVE
  To explore both laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RRC), focusing specifically on the oncologic parameters and comorbidity of the procedures. Reported complications from major centres are identified and categorised via the Clavien system. Positive margins rates, local recurrence, and both cancer-specific survival (CSS) and overall survival rates are assessed.
  
  
  METHODS
  A comprehensive electronic literature search was conducted in November 2010 using the Medline database to identify publications relating to laparoscopic, robotic, or minimally invasive radical cystectomy.
  
  
  RESULTS
  There are encouraging short- to medium-term results for both LRC and RRC in terms of postoperative morbidity and oncologic outcomes. It seems possible in experienced hands to perform a satisfactory minimally invasive lymphadenectomy regarding lymph node counts and levels of dissection. Positive soft-tissue margins are similar to large open series for T2/T3 disease but inferior for bulky T4 disease. Local recurrence rates and CSS rates seem equivalent to ORC at up to 3 yr of follow-up; however, mature outcome data still need to be presented before definitive comparisons can be made.
  
  
  CONCLUSIONS
  Robotic and laparoscopic cystectomy has a growing role in the management of muscle-invasive BCa. Long-term oncologic results are awaited, and there are concerns over the ability of MIRC to treat bulky and locally advanced disease, making careful patient selection vital. Forthcoming randomised trials in this area will more fully address these issues.
authors.affiliation: The Urology Centre, Guy's and Thomas' NHS Foundation Trust and KCL, London, UK. benchallacombe@doctors.net.uk
authors.forename: Ben J
authors.initials: BJ
authors.lastname: Challacombe
authors.forename: Bernard H
authors.initials: BH
authors.lastname: Bochner
authors.forename: Prokar
authors.initials: P
authors.lastname: Dasgupta
authors.forename: Inderbir
authors.initials: I
authors.lastname: Gill
authors.forename: Khurshid
authors.initials: K
authors.lastname: Guru
authors.forename: Harry
authors.initials: H
authors.lastname: Herr
authors.forename: Alexander
authors.initials: A
authors.lastname: Mottrie
authors.forename: Raj
authors.initials: R
authors.lastname: Pruthi
authors.forename: Joan Palou
authors.initials: JP
authors.lastname: Redorta
authors.forename: Peter
authors.initials: P
authors.lastname: Wiklund
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control; D002277:Carcinoma / Q000401:mortality / Q000601:surgery*; D015653:Cystectomy / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology*; D012371:Robotics; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000601:surgery*; D013520:Urologic Surgical Procedures / Q000295:instrumentation / Q000379:methods*