Open versus laparoscopic radical cystectomy

Objectives: Radical cystectomy (RC) remains the gold standard for muscle-invasive, organ-confined urothelial carcinoma of the bladder. The main objective of the present report is to focus on morbidity and mortality, functional and oncologic outcomes as well as the keys for success of each individual RC procedure such as the transperitoneal, extraperitoneal, prostatic capsule-sparing, and laparoscopic RC. Methods: After outlining the indications for which RC is to be used in tumour therapy, the surgical procedures are described with special focus on nerve- and prostate-sparing RC. Results: In the section on lymph adenectomy, both the anatomic landmarks of where to dissect pelvic lymph nodes and the therapeutic effect of lymphadenectomy were evaluated for both open and laparoscopic surgery. When dealing with the complication rates, a multivariate regression analysis was reported, identifying the risk factors for complications after open RC. Also oncologic outcomes, with focus on recurrence-free survival rates, and number of dissected lymph nodes and positive margins were described for open surgery. Due to its infancy, laparoscopic RC still has to deal with high complication rates and the evaluation of the oncologic outcomes is based on insufficient patient information. The use of RC in elderly patients revealed the importance of referral of RC to centers of expertise. Conclusions: RC is a complex procedure that has to be performed in centers of expertise by trained surgeons. The therapeutic effect of lymphadenectomy has been clearly demonstrated and the need for standardized guidelines is obvious. A possible standard has been introduced. (c) 2006 Elsevier B.V. All rights reserved.