Bert Vorstman, MD, MS, FAAP, FRACS, FACS
Findings indicate that long-term survival rates for bladder cancer after laparoscopic surgery are comparable that those of open surgery. The study, published in BJU International indicates that prospective randomized trials comparing these two bladder cancer surgeries are warranted.
A treatment for muscle invasive and high-risk non-muscle invasive bladder cancer is the open radical cystectomy or removal of the bladder through open surgery. The other is chemo-radiation. However, conventional surgery can also lead to serious complications. Laparoscopic radical cystectomy is one of the minimally invasive procedures that some hospitals are using but there is little information on the effectiveness of these procedures for preventing cancer recurrence over the long term.
The European Association of Urology (EAU)-section of Uro-technology has been building a large database of laparoscopic radical cystectomy procedures performed across Europe to address this. Simone Albisinni, MD and Roland van Velthoven, MD, PhD, of the Université Libre de Bruxelles of Belgium lead an international team in exploring this database and found that laparoscopic radical cystectomy can lead to reliable cancer control even many years after surgery. Sixty-five 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.
The authors noted that there is growing interest for robotic-assisted radical cystectomy, another minimally invasive procedure, in the international community as well; however, many hospitals in Europe do not own a robot. Laparoscopic equipment, on the other hand, 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.
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