Introduction
Radical cystectomy is one of the most complex urological procedures. In recent years minimally invasive techniques have increased rapidly. Yet, limited is the number of studies that compare the traditional open approach with laparoscopic techniques.
Aims
To compare morbidity and mortality rates of the two approaches in a single centre of the UK.
Methods
This is a retrospective, non-randomised review of 228 radical cystectomies that were performed between January 2010 and February 2016. Primary outcome measures were operative time, complications, blood loss and length of hospital stay. Statistical analysis was performed using the SPSS software version 21.0. Quantitative values were compared with student’s t-test whereas categorical variables were compared using the Chi square test. Statistical significance was considered a result of an alpha value <0.05. A survival analysis was also conducted.
Results
Intraoperative blood loss was lower in laparoscopic surgery (855±673 vs 716±570 mL, p = 0.15), which had a significant impact in transfusion rates (p = 0.02). Operative times were lower in open surgery (339±52.9 vs 353.1±67.1 min p = 0.10), while hospital stay was lower in the laparoscopic group (16.0±13.6 vs 14.2±11.2 days, p = 0.28). 5-year survival rates were superior for patients who underwent open procedure but difference was not statistically important (p = 0.10).
Conclusion
This is, so far, the largest cohort to compare laparoscopic and open radical cystectomy. Laparoscopic approach can reduce the need for transfusion, however there was no statistically significant difference in complication rates, duration of surgery, length of hospital stay or intraoperative blood loss.
