3D laparoscopic radical cystectomy in patients with urinary bladder cancer: a prospective evaluation of safety and efficacy

Abstract

Background: Bladder cancer is one of the most common urological malignancies. Standard surgical treatment for muscle-invasive bladder cancer is open radical cystectomy (RC) with extended pelvic lymph node dissection (EPLND). Not much data is available on three-dimensional (3D) laparoscopic radical cystectomy (LRC). This study aims to prospectively evaluate safety and efficacy of 3D LRC in patients with urinary bladder cancer.

Methods: Thirty consecutive cases of 3D LRC with EPLND with ileal conduit were performed at our centre from January 2019 to June 2020. We analysed the demographic parameters, perioperative outcomes, surgical safety, rate of complications and pathological outcomes.

Results: The mean age of patients was 60.90 years. Mean body mass index (BMI) of the patients was 20.83 kg/m² and 56.67% of patients had comorbidities. Mean cystectomy time was 83.73 min, mean lymph node (LN) dissection time was 31.37 min, mean total operative time was 216.4 min and mean blood loss was 206.33 ml. Mean duration of post-op ileus was 3.77 days and mean hospital stay was 5.83 days. Mean LN yield was 17.53 (14–20). Positive surgical margin (PSM) rate was 0%. Overall complications were observed in 13.33%, of which 3.33% were major complications. Follow-up of all patients at six months was normal. None of the patients had a recurrence or mortality.

Conclusion: This study shows that 3D LRC is safe and efficacious. It may offer surgical advantage in terms of operative times, blood loss, length of stay, perioperative complications and pathological outcomes advantages like PSM rate and LN yield. Results of our study were comparable with other 3D lap RC series and better than the two-dimensional (2D) and open RC series.