Radical cystectomy for bladder cancer: сomparison of early surgical complications during laparoscopic, open-access, and video-assisted surgery
https://doi.org/10.17650/1726-9776-2015-11-3-71-78
Abstract
Objectives. To evaluate peri- and postoperative morbidity and functional results of LRC in a single-site cohort of patients, comparing it with standard open approach (ORC) and laparoscopic cystectomy with open urinary diversion (HALRC).
Subjects and methods. A prospective analysis was performed in 51 muscle-invasive and locally advanced BCa patients who underwent RC between February 2012 and March 2014 in N. N. Petrov Research Institute of Oncology, Saint-Petersburg. The final cohort included 21 ORC, 21 LRC and 9 HALRC patients. Mean patients age was 64 (38–81) years old and did not differ in all groups. Pathological stage were similar in all groups. Multivariable logistic and median regression was performed to evaluate operating time, perioperative and postoperative complications (30-d and 90-d), readmission rates, length of stay (LOS) – totally and in ICU.
Results. Operating time during LRC and HALRC was longer than that of ORC (398 min vs 468 min vs 243 min, respectively). Despite that, there was no statistically significant influence of type of surgery on intraoperative complications – 14.3 % in ORC group, 11.1 % in HALRC and 4.7 % in LRC patients. Major complication rates (Clavien grade 3; 23.8 % vs 33.3 % vs 19.4 %) were similar between all groups. However, LRC had 4,0 times lower rate of minor complications (Clavien grade 1–2) compared to ORC (4.7 % vs 19.0 %). LRC had a significantly shorter LOS (27.8 d vs 32.6 d vs 22.6 d in ORC, HALRC and LRC groups, respectively), but no significant differences in ICU stay existed (5.1 d vs 3.1 d vs 2.1 d). Morbidity were present by one patient in each group (medium rate 5,8 %). The common transfusion rate during and after surgical intervention was 19.6 % and was higher in ORC group (33.3 % vs 4.7 % in LRC); as well, intraoperative bleeding was lower in minimally invasive techniques – the average volume of blood loss was 285 ml in LRC and did not differ between HALRC and ORC groups – 468 and 577 ml, respectively. Depending on the timing of complications, there were 30-d complications in 19 patients (37,2 %) and 90-d in 27 (52,9 %). The greatest difference was observed between any grade gastrointectinal complications (foremost, ileus) with significantly better outcomes in LRC patients – 14.2 %, compared with 47.6 % and 55 % in ORC and HALRC, respectively.
Conclusions. We found that LRC is safe and associated with lower blood loss, decreased postoperative ileus and lower LOS compared with ORC. Using a population-based cohort, we found that laparoscopic surgery for bladder cancer decreased minor complications (mainly due to lower bleeding and gastrointestinal complication rate) and had no impact on major complications.
About the Authors
A. K. NosovRussian Federation
S. A. Reva
Russian Federation
I. B. Dzhalilov
Russian Federation
S. B. Petrov
Russian Federation
References
1. Злокачественные новообразования в России в 2010 году (заболеваемость и смертность). Под ред. В.И. Чиссова, В.В. Старинского, Г.В. Петровой. М., 2012. 260 с. [Malignant neoplasm in Russia in 2010 (morbidity and mortality). Ed. V. Chissov,V. Starinsky, G. Petrova. Moscow, 2012. 260 p. (In Russ.)].
2. Lawrentschuk N., Colombo R., Hakenberg O.W. et al. Prevention and management of complications following radical cystectomy for bladder cancer. Eur Urol 2010;57:983–1001.
3. Hollenbeck B.K., Miller D.C., Taub D. et al. Identifying risk factors for potentially avoidable complications following radical cystectomy. J Urol 2005;174:1231–7.
4. Shabsigh A., Korets R., Vora K.C. et al. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methology. Eur Urol 2009;55:164–76.
5. Chang S.S., Cookson M.S., Baumgartner M.G. et al. Analysis of early complications after radical cystectomy: results of a collaborative care pathway. J Urol 2002;167:2012–6.
6. Johnson D.E., Lamy S.M. Complications of a single stage radical cystectomy and ileal conduit diversion: review of 214 cases. J Urol 1977;117:171–3.
7. Skinner D.G., Crawford E.D., Kaufman J.J. Complications of radical cystectomy for carcinoma of the bladder. J Urol 1980;123:649–53.
8. Thomas D.M., Riddle P.R. Morbidity and mortality in 100 consecutive radical cystectomies. Br J Urol 1982;54:716–9.
9. Daneshmand S., Ahmadi H., Schuckman A.K. et al. Enhanced recovery after surgery in patients undergoing radical cystectomy for bladder cancer. J Urol 2014;192(1):50–6.
10. Hautmann R.E., Abol-Enein H., Davidsson T. et al. ICUD-EAU International Consultation on Bladder Cancer 2012: urinary diversion. Eur Urol 2013;(63):67–80.
11. Menon M., Hemal A.K., Tewari A. et al. Nerve-sparing robot-assisted radical cystprostatectomy and urinary diversion. BJU Int 2003;92(3):232–6.
12. Challacombe B.J., Bochner B.H., Dasgupta P. et al. The role of laparoscopic and robotic cystectomy in the management of muscle-invasive bladder cancer with special emphasis on cancer control and complications. Eur Urol 2011;60(4):767–75.
13. Smith A.B., Raynor M., Amling C.L. et al. Multi-institutional analysis of robotic radical cystectomy for bladder cancer: periopetative outcomes and complications in 227 patients. J Laparoendosc Adv Surg Tech A 2012;22:17–21.
14. Паршин А.Г. Радикальная цистэктомия с отведением мочи в сегмент подвздошной кишки: результаты и осложнения (клиническое исследование). Автореф. дис. … канд. мед. наук. 2004. 159 с. [Parshin A.G. Radical cystectomy withurine diversion to ileum segment: results and complications (clinical study). Synopsis of thesis … of Ph.D. Med. 2004;159 p. (In Russ.)].
15. Stenzl A., Cowan N.C., De Santis M. et al. Treatment of muscle-invasive and metastatic bladder cancer: update of the EAU guidelines. Eur Urol 2011;59(6):1009–18.
16. Somani B.K., Gimlin D., Fauers P., N’dow J. Quality of life and body image for bladder cancer patients undergoing radical cystectomy and urinary diversion – a prospective cohort study with a systematuc review of literature. Urology 2009;74: 1138–43.
17. Philip J., Manikandan R., Venugopal S. et al. Orthotopic neobladder versus ileal conduit urinary diversion after cystectomy – a quality-of-life based comparison. Ann R Coll Surg Engl 2009;91:565–9.
18. Петров С.Б., Левковский Н.С., Король В.Д., Паршин А.Г. Радикальная цистэктомия как основной метод лечения мышечно-инвазивного рака мочевого пузыря (показания, особенности техники, профилактика осложнений). Практическая онкология 2003;4(4):225–30. [Petrov S.B., Levkovskiy N.S., Korol V.D., Parshin A.G. Radical cystectomy as the main method of muscular invasive bladder cancer (indications, special features of procedure, prevention of complications). Prakticheskaya onkologiya = Practical Oncology 2003;4(4):225–30. (In Russ.)].
19. Gill I.S., Kaouk J.H., Meraney A.M. et al. Laparoscopic radical cystectomy and continent orthotopic ileal neobladder performed completely intracorporeally: the initial experience. J Urol 2002;168: 13–8.
20. Dindo D., Demartines N., Clavien P.A. Classification of surgical complications. A new propisal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2005;240:205–13.
21. Martin II R.C., Brennan M.F., Jaques D.P. Quality of complication reporting in the surgical literature. Ann Surg 2002;235:803–13.
22. Azzouni F.S., Din R., Rehman S. et al. The first 100 consecutive, robot-assisted, intracorporeal ileal conduits: evolution of technique and 90-day outcomes. Eur Urol 2014;63(4):637–43.
23. Huang J., Lin T., Liu H. et al. Laparoscopic radical cystectomy with orthotopoic ileal neobladder for bladder cancer: oncologic result of 171 cases with a median 3-year follow- p. Eur Urol 2010;58(3):442–9.
24. Ng C.K., Kauffman E.C., Lee M.M. et al. A comparison of postoperative complications in open versus robotic cystectomy. Eur Urol 2010;57(2):274–81.
25. Hendrickson J.E., Hillyer C.D. Noninfectious serious hazards of transfusion. Anesth Analg 2009;108:759–69.
26. Kox M.L., El-Galley R., Busby G.E. Robotic versus open radical cystectomy: identification of patients who benefit from the robotic approach. J Endourol 2013;27:40–4.
27. Castillo O.A., Abreu S.C., Mariano M.B. et al. Complications in laparoscopic radical cystectomy. The South American experience with 59 cases. Int Braz J Urol 2006;32(3):300–5.
28. Ramirez J.A., McIntosh A.G., Strehlow R. et al. Definition, incidence, risk factors and prevention of paralytic ileus following radical cystectomy: a systematic review. Eur Urol 2013;64(4):588–97.
29. Chang S.S., Baumgartner R.G., Wells N. et al. Causes of increased hospital stay after radical cystectomy in a clinical pathway setting. J Urol 2002;167:208–11.
30. Anderson C.B., Morgan T.M., Kappa S. et al. Ureteroenteric anastomotic strictures after radical cystectomy - does operative approach matter? J Urol 2013;189(2):541–7.
31. Albisinni S., Limani K., Ingels L. et al.Long-term evaluation of oncologic and functional outcomes after laparoscopic openassisted radical cystectomy: a matched-pair analysis. World J Urol 2014, in press.
32. Madersbacher S., Schmidt J., Eberle J.M. et al. Long-term outcome of ileal conduit. J Urol 2003;169(3):985–90.
Review
For citations:
Nosov A.K., Reva S.A., Dzhalilov I.B., Petrov S.B. Radical cystectomy for bladder cancer: сomparison of early surgical complications during laparoscopic, open-access, and video-assisted surgery. Cancer Urology. 2015;11(3):71-78. (In Russ.) https://doi.org/10.17650/1726-9776-2015-11-3-71-78