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Inicio Actas Urológicas Españolas (English Edition) Post-surgical complications in patients with bladder cancer treated with cystect...
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Vol. 43. Issue 6.
Pages 305-313 (July - August 2019)
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Vol. 43. Issue 6.
Pages 305-313 (July - August 2019)
Original article
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
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D. Subirá-Ríos
Corresponding author
ibydoc71@hotmail.com

Corresponding author.
, F. Herranz-Amo, M. Moralejo-Gárate, J. Caño-Velasco, T. Renedo-Villar, G. Barbas-Bernardos, G. Bueno-Chomón, E. Rodríguez-Fernández, C. Hernández-Fernández
Servicio de Urología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Tables (5)
Table 1. Baseline clinical characteristics according to surgical approach.
Table 2. Baseline characteristics of patients managed by laparoscopic approach according to the determined periods.
Table 3. Baseline characteristics of patients according to the determined periods.
Table 4. Intraoperative, pathological variables and postoperative complications according to the determined periods.
Table 5. Comparison between the control group (open cystectomy) (2003–2005) and the laparoscopic cystectomy groups.
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Abstract
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 2 homogeneous 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.

Keywords:
Postoperative complications
Cystectomy
Laparoscopy
Open surgery
Resumen
Introducción

La cirugía mínimamente invasiva en la cistectomía no ha tenido el mismo desarrollo que en otras cirugías urológicas, entre otros motivos por la falta de estudios publicados que definan las ventajas de este abordaje frente a la cirugía abierta.

Objetivos

El principal objetivo de este estudio es establecer el papel de la cirugía mínimamente invasiva, laparoscopia, en la cistectomía radical frente a la cirugía abierta en un análisis de complicaciones perioperatorias.

Material y método

Análisis de cohortes retrospectivo de complicaciones perioperatorias de 2series homogéneas de cistectomías: laparoscópica (n=196) frente a abierta (n=197). Identificación mediante análisis multivariante de factores independientes predictores de complicaciones perioperatorias.

Resultados

En el análisis comparativo entre el abordaje laparoscópico y el abierto observamos una menor tasas de trasfusión perioperatoria (p<0,0001), una menor tasa de complicaciones postoperatorias globales (p<0,0001) así como en el subgrupo de complicaciones graves (Clavien>3; p<0,001). También una menor tasa de mortalidad en la serie de laparoscópica frente a la abierta (p<0,0001). Identificamos como factor independiente predictor de complicaciones al abordaje quirúrgico y la duración de la cirugía (p<0,001).

Conclusiones

En nuestro estudio identificamos el abordaje laparoscópico como protector de complicaciones en la cistectomía radical. El abordaje abierto casi triplica el riesgo de tener complicaciones.

Palabras clave:
Complicaciones posquirúrgicas
Cistectomía
Laparoscopia
Cirugía abierta

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