[Laparoscopic radical cystectomy. The new gold standard for bladder carcinoma?]

Abstract

Summary objectives: The experience of a renowned Latin American laparoscopic center is reported and the differences with the open technique are thoroughly discussed.

Methods: During a 7 year period a total of 85 laparoscopic cystectomies were performed; in 92%of the cases urinary diversion was performed extracorporeally. This accounted for: 14 anterior exanterations, 50 radical cystoprostatectomies, 7 radical cystectomies and 14 simple cystectomies. Male to female ratio was 3:1. Mean patient age was 63 years (range 29 to 83). Mean Body Mass Index (BMI) was 28 kg/m2(range 20 to 47). Operative data and long term results are analyzed.

Results: All 85 procedures were completed laparoscopically without need for conversion to open surgery. Orthotopic neobladder, Santiago pouch, Studer, Fontana and Le Bag were performed in 42, 13, 16, 12 and 1 case respectively. Ileal conduit, Indiana pouch and Mainz II were employed in 24, 10 and 9 cases respectively. All Mainz II were performed intracorporeally. Mean operative time and blood loss were 279 minutes (range 180 to 375) and 436 ml (range 50 to 1.500) respectively. A total of 8 patients (11%) presented perioperative complications: 5 vascular lesions, 2 eviscerations and 2 septicemias. Delayed complications were observed in 7 cases (9%); 3 urinary sepsis, 1 ureteral stenosis, 2 spontaneous ruptures and 1 mesenteric ischemia. Mean hospital stay was 8.8 days (range de 4 to 28). There was no operative mortality. Mean follow-up was 18 months (range 2 to 68 months). Ten patients (13%) presented disease progression and death.

Conclusions: Laparoscopic radical cystectomy is associated with diminished operative bleeding, time to oral intake and hospital stay. Though this is a reproducible technique it demands a very long learning curve.