Laparoscopic radical prostatectomy compared to open radical prostatectomy: Comparison between surgical time, complications and length of hospital stay. / Prostatectomía radical laparoscópica frente a prostatectomía radical abierta: comparación del tiempo quirúrgico, complicaciones y estancia postoperatoria.

INTRODUCTION: There are very few articles comparing open radical prostatectomy (OPR) with laparoscopic radical prostatectomy (LRP). OBJETIVES: To compare the surgical time, the postoperative complications and the hospital stay in patients with localized prostate cancer treated with ORP or LRP. MATERIAL AND METHODS: Comparison between two patients cohorts (312 with ORP and with 206 LRP) between 2007-2015. Postoperative complications were collected as defined in to the EAU Guidelines recommendations and they were classified according to the Clavien-Dindo classification. To compare the qualitative variables, we employed the chi-squared test and ANOVA for quantitative variables. We performed a multivariate analysis using logistic regression with dependent qualitative variables and a lineal regression with dependent continuous variables. RESULTS: The mean duration of ORP was 3:05hours and 4:35hours for LRP (p=.0001). The 26.4% of the patients presented any postoperative complication. 31.2% of ORP and 19.3% of LRP (p=.003). The mean of hospital stay was 4 days. In ORP group was 4 days in contrast to LRP with 3 days (p=.008). The LRP (p=.0001), lymphadenectomy (p=.02) and nerve-sparing (p=.01) were independent predictor factors of extension of surgical time. LRP was a protector independent factor of complications (OR=0.48 p=.007). The type of prostatectomy didn't influence in the length of hospital stay. CONCLUSIONS: LRP showed higher surgical time, less complications and it didn't influence the hospital stay.

Influence of laparoscopic access in cancer-specific mortality of patients with pTa-2pN0R0 bladder cancer treated with radical cistectomy. / Influencia del acceso laparoscópico en la mortalidad cáncer-específica de los pacientes con cáncer de vejiga en un estadio pTa-2pN0R0 tratados con cistectomía radical.

INTRODUCTION AND OBJECTIVE: Minimally invasive surgery represents an attractive surgical approach in radical cystectomy. However, its effect on the oncological results is still controversial due to the lack of definite analyses. The objective of this study is to evaluate the effect of the laparoscopic approach on cancer-specific mortality. MATERIAL AND METHOD: A retrospective cohort study of two groups of patients in a pT0-2pN0R0 stage, undergoing open radical cystectomy (ORC) (n=191) and laparoscopic radical cystectomy (LRC) (n=74). Using Cox regression, an analysis has been carried out to identify the predictor variables in the first place, and consequently, the independent predictor variables related to survival. RESULTS: 90.9% were males with a median age of 65years and a median follow-up period of 65.5 (IQR27.75-122) months. Patients with laparoscopic access presented a significantly higher ASA index (P=.0001), a longer time between TUR and cystectomy (P=.04), a lower rate of intraoperative transfusion (P=.0001), a lower pT stage (P=.002) and a lower incidence of infection associated with surgical wounds (P=.04). When analyzing the different risk factors associated with cancer-specific mortality, we only found the ORC approach (versus LRC) as an independent predictor of cancer-specific mortality (P=.007). Open approach to cystectomy multiplied the risk of mortality by 3.27. CONCLUSIONS: In our series, the laparoscopic approach does not represent a risk factor compared to the open approach in pT0-2N0R0 patients.

Influence of the laparoscopic approach on cancer-specific mortality of patients with stage pt3-4 bladder cancer treated with cystectomy. / Influencia del acceso laparoscópico en la mortalidad cáncer específica de los pacientes con cáncer de vejiga en un estadio pT3-4 tratados con cistectomía.

INTRODUCTION AND AIM: The main aim of the study was to establish the oncological safety of the laparoscopic approach to radical cystectomy for high-risk, non-organ-confined urothelial tumours. MATERIAL AND METHODS: A retrospective cohort study of 216 stage pT3-4 cystectomies operated between 2003 and 2016; using an open approach (ORC, n=108), and using a laparoscopic approach (LRC, n=108). RESULTS: Both groups have similar pathological features except, in G3 TUR, there were more lyphadenectomies and greater pN+, and more adjuvant chemotherapies using the LRC. The median follow-up of the series was 15 (IQR: 8-10.5) months. Sixty-eight point one percent of the series relapsed, with no differences between either group (p=.11). The estimated differences for cancer-specific survival was greater in the LRC group (p=.03), as was overall survival (p=.009). There were no differences between either group in estimated recurrence-free survival (p=.26). The type of surgical approach (p=.03), pTpN stage (p=.0001), and administration of adjuvant chemotherapy (p=.003) were related to cancer-specific mortality (CSM) in the univariate analysis. Only the pTpN stage (p=.0001), and not giving adjuvant chemotherapy (p=.003) behaved as independent predictive factors of CSM. CONCLUSION: The type of surgical approach to cystectomy (ORC vs. LRC) did not influence CSM. Lymph node involvement and not giving adjuvant chemotherapy were identified as predictive factors of CSM. Our study supports the oncological safety of the laparascopic approach for cystectomy in patients with locally advanced muscle-invasive bladder tumours.

Post-surgical complications in patients with bladder cancer treated with cystectomy: Differences between open and laparoscopic approach. / Complicaciones posquirúrgicas en los pacientes con cáncer de vejiga tratados con cistectomía: Diferencias entre el abordaje abierto y laparoscópico.

INTRODUCTION: Minimally invasive surgery regarding cystectomy has not had the same development as other urological surgeries. This could be due to the lack of published studies defining the advantages of this approach versus open surgery. OBJECTIVES: The main objective of this study is to establish the role of minimally invasive surgery, laparoscopic radical cystectomy, versus open surgery by analyzing their perioperative complications. MATERIAL AND METHOD: Retrospective cohort analysis of perioperative complications of 2homogeneous series of cystectomies: laparoscopic (n = 196) versus open (n = 197). Identification of independent predictors of perioperative complications by multivariate analysis. RESULTS: In the comparative analysis between laparoscopic cystectomies and open cystectomies we observed a lower rate of perioperative blood transfusion (P < 0.0001), a lower rate of global postoperative complications (P < 0.0001) and a lower rate of serious complications (Clavien > 3; P < 0.001) in the LRC group. There was also a lower mortality rate in the laparoscopic series compared to open ones (P < 0.0001). Surgical approach and surgical time (P < 0.001) were identified as independent predictors of complications. CONCLUSIONS: We have identified the laparoscopic approach as a complication shield for radical cystectomy. The open approach almost triples the risk of complications.