Compare The Clinical Efficacy Of Laparoscopic And Open Surgery For Radical Cystectomy

Objectives:To compare the clinical efficacy of laparoscopic radical cystectomy (LRC) verus open radical cystectomy (ORC) as the treatment of bladder cancer.Methods:The clinical data of 20 cases of patients underwent LRC and 32cases of patients underwent ORC were analyzed retrospectively at our hospital between September 2011 and October 2014. All patients underwent the cystoscopy and were confirmed bladder cancer by pathological examination and there were no evidences of tumor metastasis. The parameters analyzed included operating time, blood loss, the bowel recovery time, the time of removing drainage tube, postoperative complications, the time of hospitalization stay after operation.Results:Demographic data Was comparable between group(P>0.05). There were 18 men and 2 women who underwent LRC with the age ranging from 48-year old to 72-year old, and 2 cases of T1N0M0,11 cases of T2N0M0,6 cases of T3N0-2M0,1 case of T4N0-2M0.The age of ORC with 28 men and 4 women ranged from 41-year old to 79-year old, and 2 cases of T1NOMO,16 cases of T2N0M0,11 cases of T3N0-2M0,3 cases of T4N0-2M0.The mean operating time of LRC group was (312.4±58.3)minutes and it was statistical different with the ORC group whose mean operating time was (256.2±42.4) minutes (P<0.05); the time of cystoprostatectomy with pelvic lymphadenectomy between LRC group and ORC group were 192.6±38.7min and 148.3±20.2min (P> 0.05). Mean estimated blood loss (908.5±280.6ml vs.421.7±77.8ml, P<0.05) in the open radical cystectomy group was higher than the group of LRC. The group of LRC had advantages over the group of ORC at the bowel recovery time(3.2±0.8d vs.4.4±1.6d, P=0.037) and the time of removing drainage tube(6.7±0.8d vs.7.9±2.4d, P=0.062), and it was statistical significant. Mean time of hospitalization stay after operation in the open radical cystectomy group was slightly higher(14.6±7.3d vs.17.2±9.1d, P=0.062), but the difference was not statistical significant. The number of pelvic lymph node dissection(10.1±3.2 vs.10.9±6.6, P=0.782) was similar between group. There were no tumor organizations in the surgical margins in two groups. The complication rate was 3/20 in the LRC group and 10/32 in the ORC. With a median follow-up of 11.6 months (1.5-38.4), the LRC group had 1 patient who developed cancer recurrence. The ORC group had 1 patient who developed distant metastasis and succumbed to his illness, leaving 31 patients alive and recurrence-free.Conclusion:Laparoscopic radical cystectomy has the advantage of minimal invasion, less blood loss, rapid recovery and less postoperative complications. The procedure is complex, requires advanced technique and more operation time.