The Role of Laparoscopic and Robotic Cystectomy in the Management of Muscle-Invasive Bladder Cancer With Special Emphasis on Cancer Control and Complications
Por:
Challacombe, BJ, Bochner, BH, Dasgupta, P, Gill, I, Guru, K, Herr, H, Mottrie, A, Pruthi, R, Redorta, JP, Wiklund, P
Publicada:
1 oct 2011
Resumen:
Context: Minimally invasive radical cystectomy (MIRC) techniques for the treatment of muscle-invasive bladder cancer (BCa) are being increasingly applied. MIRC offers the potential benefits of a minimally invasive approach in terms of reduced blood loss and analgesic requirements whilst striving to provide similar oncologic efficacy to open radical cystectomy (ORC). Whether quicker recovery, shorter hospital stay, and a reduction in complications are routinely achieved with MIRC remains to be proved in prospective comparisons.
Objective: To explore both laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RRC), focusing specifically on the oncologic parameters and comorbidity of the procedures. Reported complications from major centres are identified and categorised via the Clavien system. Positive margins rates, local recurrence, and both cancer-specific survival (CSS) and overall survival rates are assessed.
Evidence acquisition: A comprehensive electronic literature search was conducted in November 2010 using the Medline database to identify publications relating to laparoscopic, robotic, or minimally invasive radical cystectomy.
Evidence synthesis: There are encouraging short-to medium-term results for both LRC and RRC in terms of postoperative morbidity and oncologic outcomes. It seems possible in experienced hands to perform a satisfactory minimally invasive lymphadenectomy regarding lymph node counts and levels of dissection. Positive soft-tissue margins are similar to large open series for T2/T3 disease but inferior for bulky T4 disease. Local recurrence rates and CSS rates seem equivalent to ORC at up to 3 yr of follow-up; however, mature outcome data still need to be presented before definitive comparisons can be made.
Conclusions: Robotic and laparoscopic cystectomy has a growing role in the management of muscle-invasive BCa. Long-term oncologic results are awaited, and there are concerns over the ability of MIRC to treat bulky and locally advanced disease, making careful patient selection vital. Forthcoming randomised trials in this area will more fully address these issues. (C) 2011 European Association of Urology. Published by Elsevier B. V. All rights reserved.
Filiaciones:
Challacombe, BJ:
Guys & Thomas NHS Fdn Trust, Urol Ctr, London, England
Bochner, BH:
Mem Sloan Kettering Canc Ctr, Dept Urol, New York, NY 10021 USA
Dasgupta, P:
Guys Hosp, MRC, Ctr Transplantat, KCL, London SE1 9RT, England
Gill, I:
Univ So Calif, Keck Sch Med, USC Inst Urol, Los Angeles, CA 90033 USA
Guru, K:
Roswell Pk Canc Inst, Dept Urol, Buffalo, NY 14263 USA
Herr, H:
Mem Sloan Kettering Canc Ctr, Dept Urol, New York, NY 10021 USA
Mottrie, A:
Onze Lieve Vrouw OLV Clin Aalst, Dept Urol, Aalst, Belgium
Pruthi, R:
Univ N Carolina, Div Urol Surg, Chapel Hill, NC USA
Redorta, JP:
Univ Autonoma Barcelona, Dept Urol Oncol, Fundacio Puigvert, E-08193 Barcelona, Spain
Wiklund, P:
Karolinska Inst, Dept Mol Med & Surg, Div Urol, Stockholm, Sweden
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