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Single-session laparoscopic cystectomy and nephroureterectomy: is it real and useful choice of treatment or fiction?

ABSTRACT: Patients with recurrent high grade and/or muscle-invasive bladder cancer and concomitant upper urinary tract disease, e.g. urothelial tumors or afunctional hydronephrotic kidneys, may be candidates for simultaneous laparoscopic cystectomy and nephroureterectomy. So, such patients, especially when affected by multiple comorbidities, can benefit from the avoidance of extended laparotomy. We report our experience with simultaneous laparoscopic radical cystectomy and right nephroureterectomy in a 67-year-old-male patient affected by recurrent polyfocal high grade bladder cancer and an associated right upper tract carcinoma. This laparoscopic approach was technically successful without the need for conversion to open surgery. More than a year after the surgery, the patient is still alive, showing no tumor relapse of at the established instrumental controls. This laparoscopic approach, performed in a single session, can be safe and feasible in selected cases as an alternative approach to the open surgery, offering good oncological and functional results.

SUBMITTER: Baio R

PROVIDER: S-EPMC8428153 | biostudies-literature | 2021 Sep

REPOSITORIES: biostudies-literature

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Single-session laparoscopic cystectomy and nephroureterectomy: is it real and useful choice of treatment or fiction?

Baio Raffaele R Molisso Giovanni G Pane Alessandro A Di Mauro Umberto U Intilla Oliviero O Sanseverino Roberto R

Journal of surgical case reports 20210909 9

Patients with recurrent high grade and/or muscle-invasive bladder cancer and concomitant upper urinary tract disease, e.g. urothelial tumors or afunctional hydronephrotic kidneys, may be candidates for simultaneous laparoscopic cystectomy and nephroureterectomy. So, such patients, especially when affected by multiple comorbidities, can benefit from the avoidance of extended laparotomy. We report our experience with simultaneous laparoscopic radical cystectomy and right nephroureterectomy in a 67 ...[more]

PMID: 34512951

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Project description:BackgroundOpen radical cystectomy (ORC) and urinary diversion in patients with bladder cancer (BCa) are associated with significant perioperative complication risk.ObjectiveTo compare perioperative complications between robot-assisted radical cystectomy (RARC) and ORC techniques.Design, setting, and participantsA prospective randomized controlled trial was conducted during 2010 and 2013 in BCa patients scheduled for definitive treatment by radical cystectomy (RC), pelvic lymph node dissection (PLND), and urinary diversion. Patients were randomized to ORC/PLND or RARC/PLND, both with open urinary diversion. Patients were followed for 90 d postoperatively.InterventionStandard ORC or RARC with PLND; all urinary diversions were performed via an open approach.Outcome measurements and statistical analysisPrimary outcomes were overall 90-d grade 2-5 complications defined by a modified Clavien system. Secondary outcomes included comparison of high-grade complications, estimated blood loss, operative time, pathologic outcomes, 3- and 6-mo patient-reported quality-of-life (QOL) outcomes, and total operative room and inpatient costs. Differences in binary outcomes were assessed with the chi-square test, with differences in continuous outcomes assessed by analysis of covariance with randomization group as covariate and, for QOL end points, baseline score.Results and limitationsThe trial enrolled 124 patients, of whom 118 were randomized and underwent RC/PLND. Sixty were randomized to RARC and 58 to ORC. At 90 d, grade 2-5 complications were observed in 62% and 66% of RARC and ORC patients, respectively (95% confidence interval for difference, -21% to -13%; p=0.7). The similar rates of grade 2-5 complications at our mandated interim analysis met futility criteria; thus, early closure of the trial occurred. The RARC group had lower mean intraoperative blood loss (p=0.027) but significantly longer operative time than the ORC group (p<0.001). Pathologic variables including positive surgical margins and lymph node yields were similar. Mean hospital stay was 8 d in both arms (standard deviation, 3 and 5 d, respectively; p=0.5). Three- and 6-mo QOL outcomes were similar between arms. Cost analysis demonstrated an advantage to ORC compared with RARC. A limitation is the setting at a single high-volume, referral center; our findings may not be generalizable to all settings.ConclusionsThis trial failed to identify a large advantage for robot-assisted techniques over standard open surgery for patients undergoing RC/PLND and urinary diversion. Similar 90-d complication rates, hospital stay, pathologic outcomes, and 3- and 6-mo QOL outcomes were observed regardless of surgical technique.Patient summaryOf 118 patients with bladder cancer who underwent radical cystectomy, pelvic lymph node dissection, and urinary diversion, half were randomized to open surgery and half to robot-assisted laparoscopic surgery. We compared the rate of complications within 90 d after surgery for the open group versus the robotic group and found no significant difference between the two groups.Trial registrationClinicalTrials.gov identifier NCT01076387, www.clinicaltrials.gov.

Project description:BackgroundDuring the past two decades, laparoscopic radical nephroureterectomy (LRNU) has been proposed as an alternative technique to open radical nephroureterectomy (ORNU) and has become increasingly accepted for the treatment of patients with upper tract urothelial carcinoma (UTUC). Nevertheless, the oncologic efficacy of LRNU remains controversial, especially for the treatment of locally advanced (T3/T4 and/or N+) UTUC. In this meta-analysis, we aimed to cumulatively compare the oncological outcomes of LRNU versus ORNU.Materials and methodsThe present meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A search was conducted of three electronic databases, namely, Medline, Embase, and Cochrane Library. Outcome measurements of cancer-specific survival (CSS), overall survival (OS), intravesical recurrence-free survival (IVRFS), and recurrence-free survival (RFS), including hazard ratios (HRs) and 95% confidence intervals (CIs), were extracted and pooled.ResultsEighteen articles published from 2007 to 2020 were included in the final quantitative analysis. One study was a randomized controlled trial (RCT), and the remaining articles had a retrospective design. Among a total of 10,730 participants in the selected papers, 5959 (55.5%) and 4771 (44.5%) underwent ORNU and LRNU, respectively. The results of pooled analyses revealed no significant differences in CSS (HR 0.84, 95% CI 0.60-1.19, p = 0.33), OS (HR 0.84, 95% CI 0.62-1.13, p = 0.25), IVRFS (HR 1.08, 95% CI 0.85-1.39, p = 0.52), and RFS (HR 1.09, 95% CI 0.94-1.25, p = 0.26) between LRNU and ORNU groups. Furthermore, the results of subgroup analyses for pT3/T4 and pTany N+ populations did not confirm any statistically significant differences between LRNU and ORNU in terms of any survival parameter.ConclusionsOur present meta-analysis of current evidence suggests that LRNU and ORNU have comparable oncological outcomes in patients with UTUC, even in those with locally advanced disease. Further multicenter RCTs with large sample sizes and uniform data regarding specific surgical procedures, such as bladder cuff excision, are required to establish definitive conclusions.

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Single-session laparoscopic cystectomy and nephroureterectomy: is it real and useful choice of treatment or fiction?

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Single-session laparoscopic cystectomy and nephroureterectomy: is it real and useful choice of treatment or fiction?

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