Laparoscopic versus open radical cystectomy for patients with bladder cancer over 75-year-old: a prospective randomized controlled trial

Abstract

The aim of this study was to compare the morbidity, mortality, oncological results and quality of life between laparoscopic radical cystectomy (LRC) and open radical cystectomy (ORC) in the elderly patients over 75 years old. Between January 2012 and January 2015, 60 patients were recruited into this study, who were randomly assigned in a 1:1 ratio to either LRC or ORC group. Baseline patient characteristics, pathological factors, operative and postoperative characteristics, postoperative complications and survival data were retrospectively collected, analyzed and compared between the two groups. Patients in LRC group and ORC group had comparable baseline characteristics and pathological factors (all P > 0.05). LRC group required longer operative time (408.2 ± 76.9 vs. 311.7 ± 65.3 min, P = 0.000) and had less EBL (621.6 ± 100.7 vs. 1088.5 ± 109.4 ml, P = 0.000) compared with ORC group. The incidence of infection and ileus within 90 days after surgery in ORC group was significantly higher than LRC group(6.9% vs. 28.6%, P = 0.041; 3.4% vs. 25%, P = 0.025). At a median follow-up of 28 months (range 12–48 months), the survival analysis showed that there were no significant differences between the LRC and ORC groups in overall survival (log-rank χ2 = 0.122; P = 0.726), or progress-free survival (log-rank χ2 = 0.153; P = 0.696). In conclusion, this study confirmed that LRC could achieve similar tumor treatment efficacy compared to ORC, with fewer perioperative complications and less blood loss. We suggest that LRC should be considered as the primary intervention for patients aged over 75 years old with muscle invasive bladder cancer or non-muscle invasive bladder cancer with high risk factors.

Minimally invasive vs open radical cystectomy in patients with bladder cancer: A systematic review and meta-analysis of randomized controlled trials

“…For MIS approaches, 83 patients underwent LRC and the remaining 431 patients underwent RARC. And 5 studies compared RARC with ORC [14,15,18,20,21], 2 studies compared LRC with ORC [16,19], 1 study was a three-arm trial of ORC, LRC, and RARC [17]. The sample sizes of included studies were relatively small and only 1 study included more than 150 patients [14].…”

“…Two studies included the same cohort patients, but one study reported the perioperative outcome [18], the other one reported the long-term outcomes [15]. As for the duration of follow-up, 3 studies did not reveal relevant information [18,20,21], 4 studies had a middle-term follow-up [14,16,17,19], and 1 study had a relatively long follow-up, the median duration is 4.9 years [15]. Four studies reported the rates of neoadjuvant chemotherapy (NAC), 27.5% of MIS patients used the NAC, and 36.8% of ORC patients used the NAC.…”

Minimally invasive versus open radical cystectomy for bladder cancer: A systematic review and meta-analysis

“…Thirteen articles lacked useful data and were not RCTs. Finally, eight articles reporting data from a total of nine RCTs (803 patients) [17][18][19][20][21][22][23][24] were included in the meta-analysis: six RCTs compared RARC with ORC, and three RCTs compared LRC with ORC. The baseline characteristics of the studies included in our meta-analysis are listed in Table 1.…”

Systematic review and meta-analysis on laparoscopic cystectomy in bladder cancer

“…Five articles (21)(22)(23)25,27) reported on IBL in the LRC and ORC groups. A total of 370 patients with BC were included, with 178 cases in the LRC group and 192 in the ORC group.…”

“…Three articles (22,27,28) and P=0.08) indicated that there was heterogeneity among the studies, and therefore, the research data were analyzed using the REM. Figure 6 shows the analysis results.…”