Laparoscopic radical cystectomy: neobladder or ileal conduit, debate still goes on

Abstract

Objective: To compare the pre, intra, and post-operative data between ileal conduit and neobladder urinary diversions during laparoscopic radical cystectomy(LRC).

Material and methods: Between 2006 and 2011, 63 patients who underwent LRC and urinary diversion had their data input prospectively into a database and said data used for the analysis. The outcome comparators were the patient demographics, operative time, conversion rate, blood loss, transfusion rate, morphine analgesic requirement, length of hospital stay, complication rates, follow up, and quality of life assessments. A Mantel-Haenszel test was used for dichotomous data and an inverse variance method was used for continuous data. P values less than 0.5 were considered significant.

Results: Thirty-nine patients (60 ±7.11 years) had ileal conduits and 24 patients (57 ±8.68 years) had neobladder urinary diversion. No difference was found (P >0.05) regarding age, BMI, smoking history, TURBT pathology result, blood loss, blood transfusion requirement, conversion rates, length of hospital stay, morphine requirement, complications, or follow-up and quality of life. The neobladder groups did have more previous abdominal operations and had significantly longer operative time.

Conclusions: We found no difference between either types of diversion in all comparative aspects except that the neobladder had longer operative times. This is the first comparative study between ileal conduit and neobladder urinary diversion after laparoscopic radical cystectomy and can pose as a bench mark for future comparisons.

Keywords: bladder cancer; laparoscopic radical cystectomy; laparoscopy; lymph node dissection; radical cystectomy.