Laparoscopic versus open radical cystectomy in bladder cancer: a systematic review and meta-analysis of comparative studies

Kun Tang, Heng Li, Ding Xia, Zhiquan Hu, Qianyuan Zhuang, Jihong Liu, Hua Xu, Zhangqun Ye, Kun Tang, Heng Li, Ding Xia, Zhiquan Hu, Qianyuan Zhuang, Jihong Liu, Hua Xu, Zhangqun Ye

Abstract

Background and objective: More recently laparoscopic radical cystectomy (LRC) has increasingly been an attractive alternative to open radical cystectomy (ORC) and many centers have reported their early experiences in the treatment of bladder cancer. Evaluate the safety and efficacy of LRC compared with ORC in the treatment of bladder cancer.

Methods: A systematic search of Medline, Scopus, and the Cochrane Library was performed up to Mar 1, 2013. Outcomes of interest assessing the two techniques included demographic and clinical baseline characteristics, perioperative, pathologic and oncological variables, and post-op neobladder function and complications.

Results: Sixteen eligible trials evaluating LRC vs ORC were identified including seven prospective and nine retrospective studies. Although LRC was associated with longer operative time (p<0.001), patients might benefit from significantly fewer overall complications (p<0.001), less blood loss (p<0.001), shorter length of hospital stay (p<0.001), less need of blood transfusion (p<0.001), less narcotic analgesic requirement (p<0.001), shorter time to ambulation (p = 0.03), shorter time to regular diet (p<0.001), fewer positive surgical margins (p = 0.006), fewer positive lymph node (p = 0.05), lower distant metastasis rate (p = 0.05) and fewer death (p = 0.004). There was no significant difference in other demographic parameters except for a lower ASA score (p = 0.01) in LRC while post-op neobladder function were similar between the two groups.

Conclusions: Our data suggest that LRC appears to be a safe, feasible and minimally invasive alternative to ORC with reliable perioperative safety, pathologic & oncologic efficacy, comparable post-op neobladder function and fewer complications. Because of the inherent limitations of the included studies, further large sample prospective, multi-centric, long-term follow-up studies and randomized control trials should be undertaken to confirm our findings.

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1. Flow chart of studies identified,…
Figure 1. Flow chart of studies identified, included, and excluded.
Figure 2. Forest plot and meta-analysis of…
Figure 2. Forest plot and meta-analysis of operating time.
LRC = laparoscopic radical cystectomy; ORC = open radical cystectomy.
Figure 3. Forest plot and meta-analysis of…
Figure 3. Forest plot and meta-analysis of narcotic analgesic requirement.
LRC = laparoscopic radical cystectomy; ORC = open radical cystectomy.
Figure 4. Forest plot and meta-analysis of…
Figure 4. Forest plot and meta-analysis of estimated blood loss (EBL).
LRC = laparoscopic radical cystectomy; ORC = open radical cystectomy.
Figure 5. Forest plot and meta-analysis of…
Figure 5. Forest plot and meta-analysis of blood transfusion rate.
LRC = laparoscopic radical cystectomy; ORC = open radical cystectomy.
Figure 6. Forest plot and meta-analysis of…
Figure 6. Forest plot and meta-analysis of length of hospital stay (LOS).
LRC = laparoscopic radical cystectomy; ORC = open radical cystectomy.
Figure 7. Forest plot and meta-analysis of…
Figure 7. Forest plot and meta-analysis of time to regular diet.
LRC = laparoscopic radical cystectomy; ORC = open radical cystectomy.
Figure 8. Forest plot and meta-analysis of…
Figure 8. Forest plot and meta-analysis of time to regular diet.
LRC = laparoscopic radical cystectomy; ORC = open radical cystectomy.
Figure 9. Forest plot and meta-analysis of…
Figure 9. Forest plot and meta-analysis of positive lymph node.
LRC = laparoscopic radical cystectomy; ORC = open radical cystectomy.
Figure 10. Forest plot and meta-analysis of…
Figure 10. Forest plot and meta-analysis of positive surgical margins.
LRC = laparoscopic radical cystectomy; ORC = open radical cystectomy.
Figure 11. Forest plot and meta-analysis of…
Figure 11. Forest plot and meta-analysis of distant metastasis rate.
LRC = laparoscopic radical cystectomy; ORC = open radical cystectomy.
Figure 12. Forest plot and meta-analysis of…
Figure 12. Forest plot and meta-analysis of death.
LRC = laparoscopic radical cystectomy; ORC = open radical cystectomy.
Figure 13. Forest plot and meta-analysis of…
Figure 13. Forest plot and meta-analysis of overall complications.
LRC = laparoscopic radical cystectomy; ORC = open radical cystectomy.

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Source: PubMed

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