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Surgery Insight: advantages and disadvantages of laparoscopic radical cystectomy to treat invasive bladder cancer

Nature Clinical Practice Urology volume 4, pages 387–394 (2007)Cite this article

Abstract

Laparoscopic radical cystectomy (LRC) is a challenging technique, but it has been proposed as an alternative to open radical cystectomy (ORC), which is currently the gold standard treatment for muscle-invasive or high-risk superficial bladder cancer. So far, approximately 200 cases treated with LRC have been reported in the peer-reviewed literature, but follow-up has generally been short (all <48 months). A shorter hospital stay and a quicker recovery of the patient seem to be the main advantages of LRC over ORC. Functional outcomes, cancer control obtained, and safety of the technique need to be confirmed by studies with larger cohorts of patients and longer follow-up than those previously reported, but an initial analysis suggests that LRC is not equivalent to ORC. Given that the majority of patients selected for LRC had lower American Society of Anesthesiologists scores and lower pathological stages than those in ORC studies, the proportion of patients with orthotopic neobladders (47%) and the proportion of disease-free patients (80%) seem to be suboptimal and, actually, those might represent the major disadvantages of LRC.

Key Points

  • Laparoscopic radical cystectomy (LRC) should be viewed as an experimental surgical procedure, but its main advantages are low blood loss, short associated hospital stay, and quick recovery

  • Cancer control, blood loss and hospital stay are generally similar to those for open radical cystectomy (ORC), but mortality, morbidity and positive surgical margins rates are substantially lower with LRC

  • A possible explanation for the differences in outcomes between LRC and ORC could be that patients in LRC series had lower pathological stage and Americal Society of Anesthetists scores

  • The proportion of patients with orthotopic neobladders and who remain disease free seems to be suboptimal compared with ORC, and might actually represent major disadvantages of LRC

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Authors and Affiliations

  1. the Urology Department of the National Institute for Cancer Research in Genoa, P Puppo is Head of, and C Introini and A Naselli are Consultants in, Italy.,

    Paolo Puppo, Carlo Introini & Angelo Naselli

Authors
  1. Paolo Puppo
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  2. Carlo Introini
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  3. Angelo Naselli
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Correspondence to Paolo Puppo.

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The authors declare no competing financial interests.

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Puppo, P., Introini, C. & Naselli, A. Surgery Insight: advantages and disadvantages of laparoscopic radical cystectomy to treat invasive bladder cancer. Nat Rev Urol 4, 387–394 (2007). https://doi.org/10.1038/ncpuro0840

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