Laparoscopic Radical Cystectomy For Cancer: Oncological Outcomes At Up To 5 Years

Main Category: Urology / Nephrology
Also Included In: Cancer / Oncology
Article Date: 30 Sep 2007 - 0:00 PDT

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UroToday.com- This article published in the British Journal of Urology International by Georges-Pascal and Gill detail the oncologic findings and short-term recovery from laparoscopic radical cystectomy for clinically organ confined bladder cancer. The authors evaluated 37 patients who underwent laparoscopic radical cystectomy from 1999 to 2005. There was equal distribution of patients receiving a neobladder and an ileal conduit. The initial 17 patients had laparoscopic cystectomy and urinary diversion done intracorporeally and the subsequent 20 patients had the urinary diversion done extracorporeally. A limited node dissection was done on the initial 11 patients by the subsequent 26 patients had an extended lymph node dissection.

The authors reported that the disease free survival after the laparoscopic radical cystectomy appeared to be similar to historical controls of open radical cystectomy for similarly staged patients. Obviously the small number of patients included in this study limits the ability to make definitive considerations but importantly there was no evidence of a pelvic or port site recurrence. The complication rates are significantly higher in patients who underwent an intracorporeal urinary diversion and this prompted the change to an extracorporeal formation of the urinary diversion. The length of hospital stay and pain management was similar to the open technique. Pathologically, there were two patients who had positive surgical margins: one with T3a and one with T4a disease. Whether these patients would have had a negative surgical margin with the open surgical technique is unknown.

This article demonstrates the feasibility of performing laparoscopic radical cystectomy and urinary diversion. Important information from this study is that even in expert hands the intracorporeal urinary diversion is problematic and should be done extracorporeally.

Further data with more patients and longer term follow up is required to determine the oncological benefit or equivalence to the open radical cystectomy however, the major concern of pelvic or port site recurrence was not found in this study.

Georges-Pascal H, Gill IS

BJU International. 100(1):137-142, July 2007
doi:10.1111/j.1464-410X.2007.06865.x

Reported by UroToday.com Contributing Editor David P. Wood, M.D

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