Laparoscopic Radical Cystectomy Versus Extraperitoneal Radical Cystectomy: Is the Extraperitoneal Technique Rewarding?

The surgical approach is an important factor in the development of postoperative ileus (POI) after radical cystectomy (RC); however, studies comparing extraperitoneal open radical cystectomy (EORC) and laparoscopic RC (LRC) are lacking. We retrospectively studied 41 LRCs and 53 EORCs performed by a single surgeon. In our experience, EORC had a POI rate similar to that of LRC, despite the presence of factors favoring LRC, and was associated with similar oncologic outcomes, indicating that extraperitoneal LRC could be a promising method for improving the perioperative results. Background: To study whether extraperitoneal radical cystectomy (EORC) accelerates the postoperative recovery of bowel function compared with laparoscopic radical cystectomy (LRC). Patients and Methods: All the patients with bladder cancer who underwent EORC or LRC with an ileal conduit by a single surgeon from January 2009 to June 2014 were investigated. The perioperative outcomes and follow-up data were analyzed, with a focus on postoperative ileus (POI). Results: A total of 41 LRCs and 53 EORCs met the inclusion criteria. LRC was associated with a significant reduction in the estimated blood loss (278 vs. 356 mL, P = .017) and a shorter hospital stay (8.1 vs. 9.2 days, P = .003). However, LRC was also associated with longer operative times (349 vs. 316 minutes, P = .022). The incidence of paralytic POI was 7.3% (3 of 41) and 7.5% (4 of 53; P = .966) and the obstructive POI rate was 4.9% (2 of 41) and 3.8% (2 of 53; P = .792) for the LRC and EORC groups, respectively. No significant differences were noted in blood transfusion requirements, interval to flatus or liquid intake, or opioid dosage. No patient in either group had positive surgical margins, and no significant differences were observed in the lymph node count (P = .112). At a median follow-up period of 28.7 months (range, 3-62 months), no significant differences were seen between the LRC and EORC groups in the 3-year overall, cancer-specific, or cancer-free survival rates. Conclusion: EORC resulted in a POI rate similar to that of LRC, despite factors favoring LRC. Our results suggest that extraperitoneal LRC could improve the perioperative outcomes.