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

Objective: 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 of16cases of patients underwent laparoscopic radicalcystectomy and25cases of patients underwent open radical cystectomy were analyzedretrospectively at our hospital between June2008and November2011. All patientsunderwent radical cystectomy, pelvic lymphadenectomy and ileal conduit urinarydiversion. In the laparoscopic radical cystectomy group the procedure of cystectomyand bilateral pelvic lymphadectomy was performed purely laparoscopically， the ilealconduit was created through the5to7cm midline incision used for specimen extraction.Indexes of operating time, blood loss, the bowel recovery time, postoperativecomplications, hospitalization stay after operation were compared.Results:16cases of patients underwent laparoscopic radical prostatectomy were allsuccessfully performed. Laparoscopic radical cystectomy and pelvic lymph nodedissection are not converted to open surgery. The mean operating time of LRC groupwere （298.9±42.5）minutes. There was statistical difference between the ORC groupwhich mean operating time was (246.8±34.8) minutes (P<0.05); Cystoprostatectomywith pelvic lymphadenectomy between LRC group and ORC group were(199.7±43.7)ml and (144.8±35.6)ml (P<0.05). The mean bleeding volume duringoperation, the bowel recovery time, hospitalization stay after operation between LRCgroup and ORC group were (518.8±186.1) ml and (900.0±443.0)ml (P<0.05);(3.9±1.1) days and(5.1±1.3) days (P<0.05);(13.8±1.4) days and(15.0±1.9) days (P<0.05)，Therewere no tumor organizations in the surgical magins in two groups. The positive rates ofpelvic lymph node dissection was20.0﹪in the ORC group and15.4﹪in the LRCgroup. The complication rate was31.25﹪in the LRC group and56﹪in the ORC（P>0.05）. The ureteral stents were removed in2weeks．There was no complication ofurinary leakage. All patients were followed up3~24months, there were no stomastenosis, renal function and electrolytes were normal, with no obvious pyelonephritisepisodes, ileal bladder stones occur within;1cases died of disease metastasis in theLRC,2patients died from original disease transfer in the ORC.Conclusion：Laparoscopic radical cystectomy has the advantage of minimal invasion，less blood loss，rapid recovery and less postoperative complications. The procedure iscomplex、 requries advanced technique for and more operation time at present.Long-term follow up is needed to confirm the tumor control.