Laparoscopic vs. open surgical access radical cystectomy with subsequent orthotopic reconstruction in the treatment of invasive urothelial carcinoma of the bladder

Introduction: Radical cystectomy combined with extended lymph node dissection is the treatment of choice for muscle-invasive bladder cancer and can be performed using open, laparoscopic, or robot-assisted surgical access. Aim: To compare the outcomes of laparoscopic (LRC) and open-access (ORC) radical cystectomy in terms of surgery, oncology, functional outcomes, and complications. Materials and methods: We conducted a retrospective study of 200 patients who had all undergone cystectomy for muscle-invasive bladder cancer within the last 4 years. All patients were divided into groups according to the surgical access: LRC in 30 patients and ORC in 170 patients. Oncologic outcomes, expressed as perioperative complications and postoperative results, were analyzed. Results: Overall survival rates were most significantly associated with the histological type, as well as the ‘positive’ lymph nodes and positive resection margin. The average duration of the procedure was shorter in ORC than in LRC (245.5 min and 345.3 min, respectively). Hospital stay was on average 9.18 days in LRC and 12.63 days in ORC, and this duration could vary depending on the type of diversion. The average blood loss in LRC (250-320 ml) was lower than that in ORC (200-720 ml). The complications rate was lower with LRC than with ORC; however, with subsequent orthotopic reconstruction, the functional results were better in ORC. Conclusions: LRC is an alternative option to ORC, considering the fewer complications, less amount of blood loss, and greater surgical precision, as well as shorter hospital stay. Orthotopic diversion has better functional outcomes in ORC.