Laparoendoscopic single-site surgery (LESS) is increasingly popular in urology. However, data on LESS radical cystectomy (LESS-RC) are immature, and no adequate comparative study has assessed conventional laparoscopic radical cystectomy (CL-RC) versus LESS-RC. The primary aim of this study was to compare efficiency and safety of LESS-RC and CL-RC for patients with bladder urothelial carcinoma (BUC).
A retrospective and case-matched control comparative analysis was performed of patients who underwent LESS-RC (n= 54) and CL-RC (n= 108) from January 2011 to June 2015. Oncologic, complication and perioperative outcomes were collected and evaluated.
LESS-RC versus CL-RC was associated with less estimated blood loss (median, 270 vs 337.5 ml; p= 0.014), postoperative pain (median, 4.0 vs 6.0 scores; p=0.001), and shorter convalescence (time to ambulation and oral intake, median, 2.5 vs 3.0 d; p=0.002 and 5.0 vs 6.0 d; p=0.004, respectively). No significant differences were noted for LESS-RC and CL-RC regarding the lymph node yield (median: 18 vs 20; p = 0.101). Median follow-up time was 33.5 mon (IQR: 23-41.3 mon) and 33 mon (IQR: 23-43 mon) for the LESS-RC and CL-RC groups, respectively. No significant differences were noted for LESS-RC and CL-RC regarding estimated 24-mo overall survival (OS) (86.7% vs 88.1%, p= 0.703), cancer-specific survival (CSS) (88.3% vs 90.9%, p= 0.539), and recurrence-free survival (RFS) (80.2% vs 87.5%, p= 0.619), even when substratified according to tumor stage (pT3 or higher) and lymph node status (pN+). Early, late and 90-d overall complication rates were similar. In multivariate analyses, LESS-RC was not associated with recurrence and worse survival rates but was associated with 90-d overall complications.
This study demonstrated that LESS-RC and CL-RC have comparable efficiency and safety for patients with BUC. Compared to CL-RC, LESS-RC was with less postoperative pain, lower estimated blood loss and more rapid convalescence, but was associated with 90-d overall complications.
Journal of endourology. 2017 Oct 01 [Epub ahead of print]
Xu Zhang, Kai Xu, Bin Lang, Bin Fu, Taoping Shi, Baojun Wang
Fuxing Road 28, Haidian DistrictBeijing, China , 100853 ; ., Zhujiang Hospital of Southern Medical University, Department of Urology , No 253 industrial road, Guangzhou, China , Guangzhou, Guangdong, China , 510282 ; ., Macao, China ; ., The First Affiliated Hospital of Nanchang University, Department of Urology, Wuhan, HuBei, China., Beijing, China ; ., Beijing, China ; .