We prospectively evaluated our perioperative and oncological results of 164 cases of laparoscopic radical cystectomy with urinary diversion, for formulating contemporary benchmarks, for future comparison of minimally invasive techniques. This is one of the largest prospective series reported from Russia of laparoscopic radical cystectomy (LRC).
MATERIALS AND METHODS:
This report was conducted between November 2012 and September 2017 in 164 patients (30 women and 134 men) who underwent LRC for bladder cancer with urinary diversion, at our institution, were enrolled in the study. Data were recorded and analyzed statistically. The mean patient age was (62.3±11.4) years, and mean BMI was (28.5±3.7) kg/m. Significant co-morbidities (ASA score 3) had 96 (58.5 %) of patients, history of abdominal surgery and clinically locally advanced disease were noted in 18 (11 %) and 86 (52.6 %), respectively. We analyzed the perioperative factors, length of hospital stay, pathological outcomes and complication rates.
Among the164 patients, 149 were submitted to an ileal conduit and 15 to a neobladder procedure for urinary diversion. Mean operating time was 306 min (range: 180-615 min) and mean blood loss was 368 mL (range: 50-2200 mL). Blood transfusion was required in 27 (16.5%) patients.
In 14.6 % of the cases with urothelial carcinoma the T-stage was pT1 or less, 37.8 % were pT2; 31.7 % and 13.4 % were classified as pT3 and pT4, respectively. 27.4 % of cases had lymph node positive disease. Mean number of lymph nodes removed was 16.7 (range 5 to 82). Positive surgical margins occurred in 2 cases (1.2 %). Mean days to flatus were 1.1, bowel movement 1.95 and inpatient stay 18.1 (range: 5-53).
There were 39 postoperative complications with 23,7 % major (Clavien grade 3 or higher). At a mean follow-up of 15 months 10 patients had disease recurrence and 22 died of the disease.
Median follow-up was 59 months. Local recurrence and distant metastases were recorded in 16 (8%) and nine (4.5%) patients, respectively. A five-year disease-free survival, cancer-specific survival, and overall survival were 75.5, 71.5, and 63.5%, respectively.
CONCLUSIONS: Our experience demonstrates that laparoscopic radical cystectomies for the treatment of bladder cancers seems to be very promising regarding surgical and oncological outcomes.