Laparoscopic radical cystectomy for cancer: oncological outcomes at up to 5 years

OBJECTIVE: To report the oncological outcomes at < or = 5 years after laparoscopic radical cystectomy (LRC), as open RC is the reference standard treatment for muscle-invasive bladder cancer, but interest in LRC is increasing at selected centres worldwide and as yet there are no long-term follow-up data. PATIENTS AND METHODS: Between December 1999 and January 2005, 37 patients (mean age 66 years) had LRC with urinary diversion for invasive bladder cancer; 26 patients (70%) also had an extended pelvic lymphadenectomy. Overall and cancer-specific survival data were obtained from patient charts, radiographic reports, telephone contact, and a check of the Social Security Death Index. RESULTS: Most tumours were transitional cell carcinoma (32, 86%), high-grade (grade III in 29, 78%) and high-stage (> or =pT2 in 26, 70%). Two patients had a positive surgical margin. The median (range) number of lymph nodes excised was 14 (2-24); seven patients (17%) had node-positive disease (pN1). Follow-up data were available for 35 patients (95%); eight (22%) completed > or = 5 years of follow-up, and the mean (range) follow-up was 31 (1-66) months. At the last follow-up, 24 patients (65%) were alive with no evidence of disease and 11 (30%) were dead, two (5%) from metastasis and nine (24%) from unrelated causes. The 5-year actuarial overall, cancer-specific and recurrence-free survival was 63%, 92% and 92%, respectively. CONCLUSION: To our knowledge, this is the first report of < or = 5-year follow-up after LRC; the data suggest that LRC provides oncological outcomes comparable to contemporary series of open RC.