Extraperitoneal versus transperitoneal laparoscopic radical cystectomy for selected elderly bladder cancer patients: a single center experience

Abstract

Objective:This study reports the initial experience of extraperitoneal laparoscopic radical cystectomy (ELRC) and compared with transperitoneal laparoscopic radical cystectomy (TLRC) in the treatment of selected elderly bladder cancer patients.Patients and Methods:A total of forty male bladder cancer patients who underwent ELRC (n=19) or TLRC (n=21) with ureterocutaneostomy were investigated. Demographic parameters, perioperative variables, oncological outcomes and follow-up data were retrospectively analyzed.Results:A significantly shorter time to exsufflation (1.5±0.7 vs 2.1±1.1 d; p=0.026) and liquid intake (1.8±0.9 vs 2.8±1.9 d; p=0.035) were observed in the ELRC group compared with the TLRC group. The incidence of postoperative ileus in the ELRC group was lower than the TLRC group (0 vs 9.5%). However, the difference had no statistical significance (p>0.05). The removed lymph node number in the ELRC group was significantly lower than the TLRC group (p<0.001). No significant differences were observed between the two groups in the overall and cancer-free survival rates (p>0.05).Conclusions:ELRC seems to be a safe and feasible surgical strategy for the selected elderly bladder cancer patients with ≤ T2 disease. The surgical and oncological efficacy of the ELRC is similar to that of the TLRC, but with faster intestinal function recovery. Further studies with a large series including different urinary diversions are needed to confirm our results and to better evaluate the benefit of ELRC in bladder cancer patients.

Extraperitoneal Laparoscopic Radical Cystectomy With Preservation of Fertility for the Treatment of Ewing Sarcoma: The First Report of a Reliable Surgical Method

“…Therefore, maintaining the integrity of the peritoneum is an effective way to reduce the adverse consequences of urine or intestinal leakage. It is worth noting that in previous studies, it was recommended that the peritoneum should be removed with the bladder wall when the tumors were located at the bladder apex or the posterior bladder wall to ensure the safety of the oncology results, and then the peritoneum was closed [7]. In addition, it has been reported that the possibility of peritoneal involvement in T1-T2 bladder cancer patients is extremely low [33], which was also observed in this study.…”

“…The trocar setting of the ELRC was identical to the one described by Lang et al [7]. The space between the laterovesical peritoneum and the external iliac vessels was separated upward along the right side of the bladder neck to the internal inguinal ring.…”

Initial experience with 161 extraperitoneal laparoscopic radical cystectomy procedures: Comparison with transabdominal laparoscopic radical cystectomy

“…Furthermore, identification of the peritoneal reflex at the top of the bladder and mobilizing the peritoneum that covers the posterosuperior surface of the bladder is an additional relatively difficult step. It has previously been reported that the peritoneum can be removed together with the bladder 20 . In our experience, after cutting the median ligament of the umbilical cord, engaging an assistant to help lift the bladder upwards in addition to pressing down on the peritoneum is a significant detail in this procedure.…”

Extraperitoneal laparoscopic radical cystectomy with intracorporeal neobladder: a comparison with transperitoneal approach

“…As shown in literature, the final step of ELRC is to separate the bladder and peritoneum [ 17 ]. With early return of peristalsis, the incidence of postoperative ileus would be lower, mainly attributed to opening the peritoneum late and close the peritoneum promptly after establishing a neobladder [ 6 ].…”