Articles

Open versus Laparoscopic Radical Cystectomy

By: Axel Heidenreichb lowast

European Urology, Volume 5 Issue 1, April 2006, Pages 385-394

Published online: 01 April 2006

Keywords: Bladder cancer, Cystectomy, Functional and oncologic outcomes, Laparoscopy, Open surgery

Abstract Full Text Full Text PDF (179 KB)

Abstract

Objectives

Radical cystectomy (RC) remains the gold standard for muscle-invasive, organ-confined urothelial carcinoma of the bladder. The main objective of the present report is to focus on morbidity and mortality, functional and oncologic outcomes as well as the keys for success of each individual RC procedure such as the transperitoneal, extraperitoneal, prostatic capsule-sparing, and laparoscopic RC.

Methods

After outlining the indications for which RC is to be used in tumour therapy, the surgical procedures are described with special focus on nerve- and prostate-sparing RC.

Results

In the section on lymphadenectomy, both the anatomic landmarks of where to dissect pelvic lymph nodes and the therapeutic effect of lymphadenectomy were evaluated for both open and laparoscopic surgery. When dealing with the complication rates, a multivariate regression analysis was reported, identifying the risk factors for complications after open RC. Also oncologic outcomes, with focus on recurrence-free survival rates, and number of dissected lymph nodes and positive margins were described for open surgery. Due to its infancy, laparoscopic RC still has to deal with high complication rates and the evaluation of the oncologic outcomes is based on insufficient patient information. The use of RC in elderly patients revealed the importance of referral of RC to centers of expertise.

Conclusions

RC is a complex procedure that has to be performed in centers of expertise by trained surgeons. The therapeutic effect of lymphadenectomy has been clearly demonstrated and the need for standardized guidelines is obvious. A possible standard has been introduced.

Keywords: Bladder cancer, Cystectomy, Functional and oncologic outcomes, Laparoscopy, Open surgery.

Footnotes

a Department of Urology, St.-Augustin Hospital, Bordeaux, France

b Division of Oncological Urology, Department of Urology, University of Cologne, Cologne, Germany

lowast Corresponding author. University of Köln, Joseph-Stelzmann Strasse 9, 50931 Cologne, Germany. Tel. +49 221 47886577; Fax: +49 221 47887901.

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