Korean J Urol.  2009 Nov;50(11):1083-1088.

Short Term Comparative Analysis of Laparoscopic and Open Radical Cystectomy with Extracorporeal Urinary Diversion

• Jeong JY
• Jeong BC
• Seo SI

Abstract

PURPOSE
We analyzed the efficacy and safety of laparoscopic radical cystectomy (LRC) compared with open radical cystectomy (ORC).
MATERIALS AND METHODS
Between November 2007 and April 2009, we performed LRC to treat bladder cancer in 23 patients and ORC in 64 patients. Data including the patients' clinical characteristics, peri-operative parameters, clinical outcomes, and oncologic outcomes were collected retrospectively and analyzed by use of the Mann-Whitney U test and chi-square test.
RESULTS
There were no significant differences in demographic data between the two groups. Operative time was longer (595.2 min vs. 453.1 min; p<0.01) in the LRC group but blood loss was less (634.8 ml vs. 1,415.9 ml; p<0.01) and fewer transfusions were required (13.0% vs. 50.0%; p=0.002) in the LRC group. Days to oral intake (5.7 days vs. 7.3 days; p<0.01), days to drain removal (10.9 days vs. 13.9 days; p=0.014), and length of hospital stay (15.2 days vs. 22.3 days; p<0.01) were shorter in the LRC group. Postoperative complications occurred in 4 cases in the LRC group and 28 cases in the ORC group (17.4% vs. 43.8%, p<0.01). There were no cases with a positive surgical margin in the LRC group and 3 cases in the ORC group. There was no significant difference in the number of lymph nodes excised (17.4 vs. 19.6; p=0.132) between groups.
CONCLUSIONS
These short-term clinical and oncological results suggest that LRC is a safe and effective method for the treatment of invasive bladder cancer.

Keyword

Cystectomy; Urinary bladder neoplasms; Laparoscopy

MeSH Terms

Cystectomy
Humans
Laparoscopy
Length of Stay
Lymph Nodes
Operative Time
Postoperative Complications
Retrospective Studies
Urinary Bladder Neoplasms
Urinary Diversion

Figure

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  Fig. 1 The 5 cm mini-laparotomy wound for extracorporeal urinary diversion (black arrow head).

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  Fig. 2 Lt. obturator nerve injury and sural nerve graft repair (white arrow head).

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  Fig. 3 Post operative pathologic T stage and N stage of LRC and ORC group. (A) LRC group. (B) ORC group. LRC: laparoscopic radical cystectomy, ORC: open radical cystectomy.

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  Fig. 4 (A) Antegrade pyelography: Lt. uretero-conduit anastomosis site stenosis (white arrow). (B) Balloon dilatation of stenotic site (white arrow).

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  Fig. 5 (A) Parastomal hernia on CT scan (white arrow). (B) Hernia defect (white arrow), ileal conduit (black arrow head). (C) Laparoscopic surgical mesh applied for parastomal hernia repair.

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