Laparoscopic Surgery for Bladder Cancer Shows Good Results

Long-term survival rates following laparoscopic radical cystectomy (LRC) for bladder cancer are comparable to those of open surgery, according to a new study.

Researchers at Université Libre de Bruxelles (ULB; Belgium), the University of Heidelberg, (Germany), and other institutions participating in a multicenter European cohort study prospectively enrolled 503 patients who underwent LRC for bladder cancer between 2000 and 2013. The data were retrospectively analyzed to explore peri- and post-operative characteristics, evaluate recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). The outcomes were also stratified according to tumor stage, lymph node (LN) involvement, and surgical margin status.

The results showed that minor complications occurred in 39% of the cohort and major complications in a further 17%. In all, 10 (2%) postoperative deaths were recorded. After five years, 66% of patients had no signs of bladder cancer recurrence, and among those followed for 10 years, 62% had no signs of recurrence. Upon analysis, tumor stage and LN involvement were significant predictors of RFS, CSS, and OS, and positive margins were significant predictors of RFS and CSS. The study was published on December 18, 2014, in BJU International.

“These results are vital to globally evaluate the efficacy of this procedure. They suggest that a laparoscopic approach to bladder cancer, when performed correctly, can be as safe as open surgery with regards to cancer control, though maintaining the benefits of a minimally invasive approach,” said lead author Simone Albisinni, MD, of ULB. “In spite of the technical difficulty and the need for a learning curve, these findings support the use of a laparoscopic approach for the management of bladder cancer.”

Open radical cystectomy (ORC, the removal of the bladder though open surgery) is the treatment of choice for muscle invasive and high-risk non-muscle invasive bladder cancer; however, the surgery can lead to serious complications. LRC could serve an attractive treatment option for selected candidates who have localized muscle-invasive bladder cancer, with the main advantages being reduced blood loss, leading to improved recovery and shorter hospital stays after the procedure.

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Université Libre de Bruxelles
University of Heidelberg