Laparoscopic Radical Cystectomy: Current Status, Outcomes, and Patient Selection

Abstract

Radical cystectomy remains the gold standard for the treatment of muscle invasive and high-risk urothelial cancers of the bladder. In attempts to decrease the morbidity of the procedure, minimally invasive techniques have been employed for both the extirpative as well as the reconstructive portions of the procedure. Current laparoscopic and robotic-assisted techniques allow for the performance of these procedures in selected patients with improvements in estimated blood loss while adhering to the oncologic principles required for cancer control including obtaining negative margins and performing an adequate extended lymph node dissection. While completely intracorporeal approaches are technically feasible, they have been, thus far, associated with significant increases in operative times and perioperative complications. Open-assisted approaches in which the extirpative portions of the case (i.e. radical cystectomy, extended lymph node dissection) are completed laparoscopically and the urinary reconstruction is performed in a limited open fashion appear to provide the best outcomes with current techniques. Intermediate cancer outcomes are promising when compared to their open surgical counterparts. While this approach remains investigational, long-term outcomes are currently being accrued and may allow for the shift of the standard of care to minimally invasive approaches for select patients as has been the case in renal and prostatic cancers.

Laparoscopic Radical Cystectomy: a 5-year review of a single institute's operative data and complications and a systematic review of the literature

“…morbidity, and more rapid return to daily activities, in addition to maintaining the same functional and oncological outcomes as ORC (1,2,4). However, despite the success numerous centres have had with LRC, it remains a matter of debate as there is no head to head trial comparing the long term outcomes and oncological results between the two modalities (1)(2)(3)5).…”

“…As it stands, almost 50% of patients who undergo ORC will have a tumour recurrence, which lead to the mortality of many of these patients, while the 5-year tumour recurrence survival rates ranges between 73 and 89% in node negative organ confined disease, 45-55% with extravesical disease, and 25-35% with nodal involvement (1)(2)(3)(4). To try to improve the survival, different centres have adopted an extended pelvic lymph node dissection (PLND) approach (1).…”

“…The complication rate of ORC is in the range of 40-65% with a transfusion requirement of around 66%, while the major complication rates range between 10-12% and a mortality of 2-3% (1,4). LRC can also provide an advantage of less blood loss, analgesic requirement, reduced scarring, and less complications (2,6).…”

Evaluation of Open and Laparoscopic Radical Cystoprostatectomy Combined with Orthotopic Neobladder: A Single-Surgeon Experience

“…In 1993, Sánchez de Badajoz et al [13] performed the first LRCP and reported faster recovery, shorter hospital stay, decreased morbidity and more rapid return to daily activities compared to ORCP [13,14,15,16,17]. In addition, they reported favorable functional and oncologic outcomes as with ORCP [13,14,15,16,17].…”

Laparoscopic cecostomy tube placement in an Indiana pouch

“…In the pediatric population with spinal dysraphism, laparoscopic cecostomy tube placement for anterograde enemas has been described. 2,3 Multiple urinary diversion procedures, such as the Studer pouch, 4 rectosigmoid pouch 5 and ileal conduit, 6 have been performed with minimally invasive intracorporeal techniques, although catheterizable cutaneous reservoirs are normally completed extracorporeally with a small laparotomy. 7 Regardless of the technique of the initial operation, proactive management options include replacement by repeat laparotomy, percutaneous placement, or, as described in this case report, laparoscopic cecostomy tube placement.…”