Bladder Cancer Survival Similar With Laparoscopic, Open Surgery

Long-term survival rates of patients after laparoscopic surgery for bladder cancer are similar to rates achieved with standard open surgery.

Long-term survival rates of patients after laparoscopic surgery for bladder cancer are similar to rates achieved with standard open surgery, according to the results of a large trial by the European Association of Urology (EAU). The results of the nine-center, 503-patient trial were published in BJU International.

Five years after laparoscopic radical cystectomy (LRC), 66% of patients had no measurable bladder cancer recurrence. Ten years after the surgery, 62% had no measurable recurrence. Overall survival rates were 62% and 38% at 5 and 10 years, respectively.

The retrospective study is the largest to date that used laparoscopic surgery, a type of minimally invasive surgery that uses a video camera.

“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 lead study author Simone Albisinni, MD, of the Université libre de Bruxelles in Brussels, Belgium, in a statement.

Based on these results, prospective randomized trials to compare the two surgical techniques are now warranted, according to the study authors.

Albisinni; Roland van Velthoven, MD, PhD, also of the Université libre de Bruxelles; and colleagues used patient data from a database of LRC procedures performed in Europe created by the EAU. Patients undergoing LRC for bladder cancer were enrolled between 2000 and 2013. Patients had a median age of 68 and 82% were male.

Removal of the bladder with open surgery is the standard treatment for patients with muscle-invasive and high-risk non–muscle-invasive bladder cancer, but the procedure can result in serious complications.

Minor and major complications occurred in 39% and 17% of patients, respectively. There were 12 cases (3.4% of patients) in which a laparoscopic surgery had to be converted to open surgery, six of which were due to uncontrolled bleeding. There were 10 (2%) postoperative deaths. Positive surgical margins were detected in 29 patients (5.8%).

Sixty patients (12%) underwent a re-operation within the first 30 days after laparoscopic surgery. “Although these rates may seem high, it must be recognized that radical cystectomy is a morbid procedure even when performed via a minimally invasive approach,” said the authors.

A more detailed analysis of postoperative complications will be available in a separate publication by the authors.

Tumor stage and lymph node involvement were significant predictors of recurrence-free survival, cancer-specific survival, and overall survival (P < .0001 for all 3 statistics); age and gender were not significant predictors.

While hospitals are beginning to use laparoscopic surgery, there have been few comparisons of the long-term efficacy of the two techniques.

“This data represents crucial information for urologists who are performing laparoscopic surgery, or who wish to implement laparoscopic cystectomy in their departments,” said Albisinni. “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.”