A prospective randomised controlled trial of laparoscopic vs open radical cystectomy for bladder cancer: perioperative and oncologic outcomes with 5-year follow-upT Lin et al

Abstract

Background: Laparoscopic radical cystectomy (LRC) is increasingly being used for muscle-invasive bladder cancer. However, high levels of clinical evidence comparing laparoscopic vs open radical cystectomy (ORC) are lacking.

Methods: A prospective randomised controlled clinical trial comparing LRC vs ORC in patients undergoing radical cystectomy for bladder cancer. Thirty-five patients were eligible for final analysis in each group.

Results: The median follow-up was 26 months (range, 4-59 months) for laparoscopic vs 32 months (range, 6-60 months) for ORC. Significant differences were noted in operative time, estimated blood loss (EBL), blood transfusion rate, analgesic requirement, and time to resumption of oral intake. No significant differences were noted in the length of hospital stay, complication rate, lymph node yield (14.1±6.3 for LRC and 15.2±5.9 for ORC), positive surgical margin rate, postoperative pathology, or recurrence rate (7 for LRC and 8 for ORC). The 5-year recurrence-free survival with laparoscopic vs ORC was 78.5% vs 70.9%, respectively (P=0.773). The overall survival with laparoscopic vs ORC was 73.8% vs 67.4%, respectively (P=0.511).

Conclusion: Our study demonstrated that LRC is superior to ORC in perioperative outcomes, including EBL, blood transfusion rate, and analgesic requirement. We found no major difference in oncologic outcomes. The number of patients is too small to allow for a final conclusion.

Figure 1

Flow chart of patients. Abbreviations: LRC=laparoscopic radical cystectomy; NMIBC=non-muscle-invasive bladder cancer; OIN=orthotopic ileal neobladder; ORC=open radical cystectomy; TURBt=transurethral resection of bladder tumour.

Figure 2

Kaplan–Meier curves for comparison of (A) recurrence-free survival (RFS) between laparoscopic radical cystectomy (LRC) and open radical cystectomy (ORC), (B) overall survival between LRC and ORC, (C) RFS in lymph node (LN)-negative patients, (D) RFS in LN-positive patients, (E) RFS according to LN status, (F) RFS according to pT stage. Abbreviations: CI=confidence interval; HR=hazards ratio.