World journal of surgical oncology · 2025
Extraperitoneal vs transperitoneal laparoscopic cystectomy: optimized surgical techniques and long-term outcomes in a single-center retrospective cohort study.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Zhu Guanqun, He Yuxuan, Wang Shicheng, Huang Jiao, Zhang Rui, Zhang Zongliang, Zhao Kai, Yin Xinbao, Yang Xiaokun, Jiang Zaiqing, Jiang Guoyi, Bae Woong Jin, Wang Ke
Аннотация
OBJECTIVE: To evaluate and compare the long-term oncologic outcomes and perioperative performance of extraperitoneal laparoscopic radical cystectomy (ELRC) versus transperitoneal laparoscopic radical cystectomy (TLRC) in patients with bladder cancer (BC).
PATIENTS AND METHODS: This retrospective single-center cohort study included 298 BC patients who underwent ELRC (n = 202) or TLRC (n = 96) between January 2020 and January 2025. Primary endpoints included overall survival (OS), cancer-specific survival (CSS), progression-free survival (PFS), and recurrence-free survival (RFS). Secondary endpoints were operative time, estimated blood loss, gastrointestinal recovery, and perioperative complications. Kaplan-Meier survival analysis, Cox regression, and subgroup analysis were used to evaluate outcomes and risk factors.
RESULTS: The mean follow-up was 25.6 months for ELRC and 30.7 months for TLRC. There were no significant differences in projected OS (HR = 0.89, P = 0.562), CSS (HR = 0.87, P = 0.492), PFS (HR = 1.09, P = 0.693), or RFS (HR = 1.16, P = 0.453) between the two groups. ELRC was associated with significantly shorter operative time, less blood loss, faster gastrointestinal recovery, and lower incidence of ileus and infections (all P < 0.05). Multivariable analysis identified pathological T stage and ASA score as independent predictors of OS. Subgroup analysis showed no significant impact of urinary diversion type or tumor stage on survival outcomes between the two approaches.
CONCLUSION: LRC may be a feasible alternative to TLRC, with potential advantages in perioperative recovery and reduced postoperative complications, while demonstrating comparable oncologic outcomes. Prospective multicenter studies with longer-term follow-up are warranted to confirm these findings.
PATIENTS AND METHODS: This retrospective single-center cohort study included 298 BC patients who underwent ELRC (n = 202) or TLRC (n = 96) between January 2020 and January 2025. Primary endpoints included overall survival (OS), cancer-specific survival (CSS), progression-free survival (PFS), and recurrence-free survival (RFS). Secondary endpoints were operative time, estimated blood loss, gastrointestinal recovery, and perioperative complications. Kaplan-Meier survival analysis, Cox regression, and subgroup analysis were used to evaluate outcomes and risk factors.
RESULTS: The mean follow-up was 25.6 months for ELRC and 30.7 months for TLRC. There were no significant differences in projected OS (HR = 0.89, P = 0.562), CSS (HR = 0.87, P = 0.492), PFS (HR = 1.09, P = 0.693), or RFS (HR = 1.16, P = 0.453) between the two groups. ELRC was associated with significantly shorter operative time, less blood loss, faster gastrointestinal recovery, and lower incidence of ileus and infections (all P < 0.05). Multivariable analysis identified pathological T stage and ASA score as independent predictors of OS. Subgroup analysis showed no significant impact of urinary diversion type or tumor stage on survival outcomes between the two approaches.
CONCLUSION: LRC may be a feasible alternative to TLRC, with potential advantages in perioperative recovery and reduced postoperative complications, while demonstrating comparable oncologic outcomes. Prospective multicenter studies with longer-term follow-up are warranted to confirm these findings.