Perioperative Outcomes of Open Extra-peritoneal Versus Laparoscopic Radical Cystoprostatectomy: A single Center Comparative Study
Urology Journal,
Vol. 21 No. 03 (2024),
11 May 2024
,
Page 175-181
https://doi.org/10.22037/uj.v21i03.7937
Abstract
Purpose: To compare 90-day perioperative complications and pathological outcomes between laparoscopic radical cystectomy (LRC) and extraperitoneal radical cystectomy (EORC) approaches.
Materials and Methods: All operations were performed in a single high-volume tertiary referee center by the same surgical team.Males ≥ 18 years with pre-cystectomy clinical T1–T3 disease and having undergone an ileal conduit were included. Exclusion criteria included patients with inflammatory bowel disease, previous pelvic and/or abdominal irradiation, neo-adjuvant chemotherapy, and/or clinical T4 disease. Perioperative outcomes such as operative time, estimated blood loss, transfusion rate, hospital stay, and 90-day complications were evaluated. The recovery duration of regular bowel activity, mean stool passage,and ileus rates were recorded.
Results: A total of 221 patients met the inclusion criteria(81 LRC and 130 EORC). Demographics and preoperative parameters were comparable. Intraoperative estimated blood lossfavored LRC by a median of 450 mL (200-900) P=.021) vs. a median of 700 mL (300-2900) for EORC. The transfusion rate did not differ between the two groups; %14.8 (N=12) for the LRC and %20.8 (N=27) for EORC (P=.37). The median hospital stay was 9 (4-49) days for EORC and 8 (4-29) days for LRC (P=.011). The need for analgesics to control pain through an epidural catheter was higher for EORC (P=.042). There was no difference in overall complication rates (P=.47).
Conclusion: Although LRC appears to have a slight advantage over EORC, both techniques yield satisfactory results in regard to ileus rates and 90-day perioperative complications.
- Laparoscopic cystectomy
- perioperative complications
- open extra-peritoneal cystectomy
How to Cite
References
Fairey AS, Jacobsen N-EB, Chetner MP, et al. Associations between comorbidity, and overall survival and bladder cancer specific survival after radical cystectomy: results from the Alberta Urology Institute Radical Cystectomy database. J Urol. 2009;182:85-93.
Novara G, De Marco V, Aragona M, et al. Complications and mortality after radical cystectomy for bladder transitional cell cancer. J Urol. 2009;182:914-21.
Cohen SA, Mirheydar HS, Parsons JK, et al. Minimally invasive cystectomy is associated with improved perioperative patient safety outcomes compared with open cystectomy in a national cohort. Urology. 2014;84(2):314-9.
Snow-Lisy DC, Campbell SC, Gill IS, et al. Robotic and laparoscopic radical cystectomy for bladder cancer: long-term oncologic outcomes. Eur Urol. 2014;65:193-200.
Huang J, Lin T, Liu H, et al. Laparoscopic radical cystectomy with orthotopic ileal neobladder for bladder cancer: oncologic results of 171 cases with a median 3-year follow-up. Eur Urol. 2010;58:442-9.
Shabsigh A, Korets R, Vora KC, et al. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol. 2009;55:164-74.
Kulkarni JN, Gulla RI, Tongaonkar HB, Kashyapi BD, Rajyaguru KB. Radical cystoprostatectomy: an extraperitoneal retrograde approach. J Urol. 1999;161:545-8.
Ozkaptan O, Cubuk A, Dinçer E, Sahan A, Kafkaslı A, Akça O. Extraperitoneal Antegrade vs Transperitoneal Open Radical Cystectomy: Single Center Experiences with 200 Cases. Bladder Cancer. 2020;6:187-194
Kulkarni JN, Agarwal H. Transperitoneal vs. extraperitoneal radical cystectomy for bladder cancer: A retrospective study. Int Braz J Urol. 2018;44:296-303.
Refaai K, Sharafeldin MA, Elabbady A, et al. Perioperative Outcomes of Open Retrograde Extraperitoneal Versus Intracorporeal Robot-assisted Radical Cystoprostatectomy in Men: A Dual-center Comparative Study. Clin Genitourin Cancer. 2020;18:e315-e23.
Zhao J, Zeng S, Zhang Z, et al. Laparoscopic radical cystectomy versus extraperitoneal radical cystectomy: is the extraperitoneal technique rewarding? Clinical genitourinary cancer. 2015;13:e271-e7.
Martin RC, Brennan MF, Jaques DP. Quality of complication reporting in the surgical literature. Annals of surgery. 2002;235(6):803.
Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Annals of surgery. 2004;240:205-13.
Hautmann RE, Abol-Enein H, Davidsson T, et al. ICUD-EAU international consultation on bladder cancer 2012: urinary diversion. European urology. 2013;63:67-80.
Choi H, Kang SH, Yoon DK, et al. Chewing gum has a stimulatory effect on bowel motility in patients after open or robotic radical cystectomy for bladder cancer: a prospective randomized comparative study. Urology. 2011;77(4):884-90.
Serel TA, SEVI˙ N G, Perk H, Koşar A, Soyupek S. Antegrade extraperitoneal approach to radical cystectomy and ileal neobladder. International journal of urology. 2003;10:25-8.
Jentzmik F, Schostak M, Stephan C, et al. Extraperitoneal radical cystectomy with extraperitonealization of the ileal neobladder: a comparison to the transperitoneal technique. World journal of urology. 2010;28:457-63.
Zhu Y-P, Ye D-W, Yao X-D, et al. Defining good candidates for extraperitoneal cystectomy: results from random peritoneum biopsies of 136 cases. Urology. 2013;81(4):820-5.
Roth B, Birkhäuser FD, Zehnder P, Burkhard FC, Thalmann GN, Studer UE. Readaptation of the peritoneum following extended pelvic lymphadenectomy and cystectomy has a significant beneficial impact on early postoperative recovery and complications: results of a prospective randomized trial. European urology. 2011;59:204-10.
Tang K, Li H, Xia D, et al. Laparoscopic versus open radical cystectomy in bladder cancer: a systematic review and meta-analysis of comparative studies. PloS one. 2014;9:e95667.
Herr HW. Extent of surgery and pathology evaluation has an impact on bladder cancer outcomes after radical cystectomy. Urology. 2003;61:105-8.
Buscarini M, Josephson DY, Stein JP. Lymphadenectomy in bladder cancer: a review. Urologia Internationalis. 2007;79:191-9.
Herr HW, Bochner BH, Dalbagni G, Donat SM, Reuter VE, Bajorin DF. Impact of the number of lymph nodes retrieved on outcome in patients with muscle invasive bladder cancer. The Journal of urology. 2002;167:1295-8.
Hollenbeck BK, Miller DC, Taub D, et al. Identifying risk factors for potentially avoidable complications following radical cystectomy. The Journal of urology. 2005;174:1231-7.
Schuster TG, Montie JE. Postoperative ileus after abdominal surgery. Urology. 2002;59:465-71.
Kauf TL, Svatek RS, Amiel G, et al. Alvimopan, a peripherally acting μ-opioid receptor antagonist, is associated with reduced costs after radical cystectomy: economic analysis of a phase 4 randomized, controlled trial. The Journal of urology. 2014;191:1721-7.
Saar M, Ohlmann CH, Siemer S, et al. Fast‐track rehabilitation after robot‐assisted laparoscopic cystectomy accelerates postoperative recovery. BJU international. 2013;112:E99-E106.
Guillotreau J, Gamé X, Mouzin M, et al. Radical cystectomy for bladder cancer: morbidity of laparoscopic versus open surgery. The Journal of urology. 2009;181:554-9.
Soleimani M, Moradkhani E, Masoumi N, Gholivandan J. Extra-Peritoneal versus Trans-Peritoneal Open Radical Cystectomy - Comparison of Two Techniques in Early Post-Operative Complications. Urol J 2021;18:519-524.
Han Yang , Zongliang Zhang , Kai Zhao et al. Initial experience with 161 extraperitoneal laparoscopic radical cystectomy procedures: Comparison with transabdominal laparoscopic radical cystectomy. Int J Urol 2023;30:155-160.
Hemal AK, Kolla SB. Comparison of laparoscopic and open radical cystoprostatectomy for localized bladder cancer with 3-year oncological followup: a single surgeon experience. The Journal of urology. 2007;178:2340-3.
Albisinni S, Rassweiler J, van Poppel H. The Future of Medical Devices in Europe Is at Stake: Concerns over the Implementation of the Medical Devices Regulation. Eur Urol. 2023;83:191-2.
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