New findings suggest that long-term survival rates following laparoscopic surgery for bladder cancer are comparable to those of open surgery. Published in BJU International, the largest study to date with long-term follow-up after this type of minimally invasive surgery, indicate that prospective randomized trials comparing these two bladder cancer surgeries are warranted.
The removal of the bladder through open surgery or ‘open radical cystectomy’ is the treatment of choice for muscle invasive and high-risk non-muscle invasive bladder cancer but the surgery can lead to serious complications. Laparoscopic radical cystectomy is still being used by some hospitals but there is little information on the effectiveness of these procedures for preventing cancer recurrence over the long term.
To address this, a large database of laparoscopic radical cystectomy procedures performed across Europe is being built by the European Association of Urology (EAU)-section of Uro-technology. An international team led by Simone Albisinni, MD and Roland van Velthoven, MD, PhD, of the Universite Libre de Bruxelles in Belgium have found from the database that laparoscopic radical cystectomy can lead to reliable cancer control even many years after surgery. About 66 percent of patients had no signs of bladder cancer recurrence after 5 years and among those followed for 10 years, 62 percent had no signs of recurrence.
“Analyzing over 500 patients and with a median follow-up of 5 years, these results are vital to globally evaluate the efficacy of this procedure. They suggest that a laparoscopic approach to bladder cancer, when performed correctly, can be as safe
as open surgery with regards to cancer control, though maintaining the benefits of a minimally invasive approach,” said Dr. Albisinni.
There is a growing interest for robotic-assisted radical cystectomy which the authors noted and another minimally invasive procedure, in the international community as well; however many hospitals in Europe do not own a robot. On the other hand, laparoscopic equipment is more widely available. “As such, this data represents crucial information for urologists who are performing laparoscopic surgery, or who wish to implement laparoscopic cystectomy in their departments. In spite of the technical difficulty and the need for a learning curve, these findings support the use of a laparoscopic approach for the management of bladder cancer,” said Dr. Albisinni.