Laparoscopic versus open radical cystectomy in 607 patients with bladder cancer: Comparative survival analysis

Abstract

Objectives: To compare perioperative and oncologic survival outcomes between laparoscopic radical cystectomy and open radical cystectomy.

Methods: A total of 607 patients underwent open radical cystectomy (n = 412) or laparoscopic radical cystectomy (n = 195) at a single academic institution from January 2006 to April 2017. Their medical records were retrospectively analyzed. One-to-one propensity score matching was carried out to reduce selection bias. Estimated blood loss and complications were compared. Overall survival, cancer-specific survival and progression-free survival estimates for all patients and patients with locally advanced bladder cancer were analyzed using the Kaplan-Meier method.

Results: Either before or after matching, the laparoscopic radical cystectomy group had less estimated blood loss (P < 0.001 and P < 0.001) and fewer complications (P < 0.001 and P = 0.008). There was no difference in the overall survival (P = 0.216 and P = 0.961) and progression-free survival (P = 0.826 and P = 0.462) for all the patients having either laparoscopic radical cystectomy or open radical cystectomy. However, the 5-year progression-free survival of open radical cystectomy was higher than that of laparoscopic radical cystectomy (P = 0.019 and P = 0.021) for patients with locally advanced bladder cancer.

Conclusions: Laparoscopic radical cystectomy is superior to open radical cystectomy in terms of perioperative outcomes, and similar to open radical cystectomy in terms of oncologic outcomes for patients with early stage bladder cancer. However, for patients with locally advanced bladder cancer, laparoscopic radical cystectomy seems to be associated with shorter progression-free survival than open radical cystectomy.

Keywords: bladder cancer; laparoscopic radical cystectomy; open radical cystectomy; propensity score matching; survival outcomes.

Fig. 1

Flowchart of all eligible patients. *The patients who were lost to follow up were from other cities, and they did not choose to be followed up in our institution, so no follow‐up data were available.

Fig. 2

Kaplan–Meier curves of OS probability, CSS probability and PFS probability in patients who underwent ORC or LRC before matching. The 5‐year OS was 0.579 versus 0.617, 5‐year CSS was 0.706 versus 0.699, and 5‐year PFS was 0.658 versus 0.622 in the ORC and LRC group, respectively. There was no significant difference in the OS probability (P = 0.216), CSS probability (P = 0.619) and PFS probability (P = 0.826).

Fig. 3

Kaplan–Meier curves of OS probability, CSS probability and PFS probability in patients who underwent ORC or LRC after matching. The 5‐year OS was 0.608 versus 0.598, 5‐year CSS was 0.718 versus 0.678, and 5‐year PFS was 0.683 versus 0.596 in the ORC and LRC group, respectively. There was no significant difference in the OS probability (P = 0.961), CSS probability (P = 0.790) and PFS probability (P = 0.462).

Fig. 4

Kaplan–Meier curves of OS probability, CSS probability and PFS probability in patients with locally advanced bladder cancer pT4 or pN+ who underwent ORC or LRC before matching. The 5‐year OS was 0.376 versus 0.460, 5‐year CSS was 0.517 versus 0.494, and 5‐year PFS was 0.489 versus 0.275 in the ORC and LRC group, respectively. There was no significant difference in the OS probability (P = 0.850) and CSS probability (P = 0.496); however, the PFS of ORC was higher than LRC (P = 0.019).

Fig. 5

Kaplan–Meier curves of OS probability, CSS probability and PFS probability in patients with locally advanced bladder cancer pT4 or pN+ who underwent ORC or LRC after matching. The 5‐year OS was 0.391 versus 0.362, 5‐year CSS was 0.467 versus 0.397, and 5‐year PFS was 0.502 versus 0.210 in ORC and LRC group, respectively. There was no significant difference in the OS probability (P = 0.397) and CSS probability (P = 0.248); however, the PFS of ORC was higher than LRC (P = 0.021).