Laparoscopic Radical Cystectomy Versus Extraperitoneal Radical Cystectomy: Is the Extraperitoneal Technique Rewarding?
BACKGROUND
To study whether extraperitoneal radical cystectomy (EORC) accelerates the postoperative recovery of bowel function compared with laparoscopic radical cystectomy (LRC).


METHODS
All the patients with bladder cancer who underwent EORC or LRC with an ileal conduit by a single surgeon from January 2009 to June 2014 were investigated. The perioperative outcomes and follow-up data were analyzed, with a focus on postoperative ileus (POI).


RESULTS
A total of 41 LRCs and 53 EORCs met the inclusion criteria. LRC was associated with a significant reduction in the estimated blood loss (278 vs. 356 mL, P = .017) and a shorter hospital stay (8.1 vs. 9.2 days, P = .003). However, LRC was also associated with longer operative times (349 vs. 316 minutes, P = .022). The incidence of paralytic POI was 7.3% (3 of 41) and 7.5% (4 of 53; P = .966) and the obstructive POI rate was 4.9% (2 of 41) and 3.8% (2 of 53; P = .792) for the LRC and EORC groups, respectively. No significant differences were noted in blood transfusion requirements, interval to flatus or liquid intake, or opioid dosage. No patient in either group had positive surgical margins, and no significant differences were observed in the lymph node count (P = .112). At a median follow-up period of 28.7 months (range, 3-62 months), no significant differences were seen between the LRC and EORC groups in the 3-year overall, cancer-specific, or cancer-free survival rates.


CONCLUSIONS
EORC resulted in a POI rate similar to that of LRC, despite factors favoring LRC. Our results suggest that extraperitoneal LRC could improve the perioperative outcomes.
Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China; Department of Urology, Yantai Yuhuangding Hospital, Shandong, People's Republic of China.
Junjie
J
Zhao
Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China.
Shuxiong
S
Zeng
Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China.
Zhensheng
Z
Zhang
Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China.
Tie
T
Zhou
Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China.
Bo
B
Yang
Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China.
Ruixiang
R
Song
Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China.
Yinghao
Y
Sun
Department of Urology, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China. Electronic address: xuchuanliang@medmail.com.cn.
Chuanliang
C
Xu
D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D045823:Ileus / Q000145:classification* / Q000453:epidemiology* / Q000209:etiology; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D014547:Urinary Diversion
Bladder cancer; Cystectomy; Ileus; Laparoscopy; Morbidity