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Vol. 41. Issue 7.
Pages 416-425 (September 2017)
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Vol. 41. Issue 7.
Pages 416-425 (September 2017)
Review article
DOI: 10.1016/j.acuroe.2017.06.001
Systematic review of perioperative outcomes and complications after open, laparoscopic and robot-assisted radical cystectomy
Revisión sistemática de resultados perioperatorios y complicaciones después de cistectomía radical abierta, laparoscópica y asistida por robot
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A. Palazzetti, R. Sanchez-Salas
Corresponding author
, P. Capogrosso, E. Barret, N. Cathala, A. Mombet, D. Prapotnich, M. Galiano, F. Rozet, X. Cathelineau
Departamento de Urología, L’Institute Mutualiste Montsouris, París, France
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Table 1. Baseline patient's characteristics in the ORC, LRC and RARC surgical series.
Table 2. Perioperative outcomes reported in open radical cystectomy series.
Table 3. Perioperative outcomes reported in laparoscopic radical cystectomy series.
Table 4. Perioperative outcomes reported in robot-assisted radical cystectomy series.
Table 5. Complications according to Clavien classification and 90-days mortality rates following ORC, LRC and RARC.
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Abstract

Radical cystectomy and regional lymph node dissection is the standard treatment for localized muscle-invasive and for high-risk non-muscle-invasive bladder cancer, and represents one of the main surgical urologic procedures. The open surgical approach is still widely adopted, even if in the last two decades efforts have been made in order to evaluate if minimally invasive procedures, either laparoscopic or robot-assisted, might show a benefit compared to the standard technique. Open radical cystectomy is associated with a high complication rate, but data from the laparoscopic and robotic surgical series failed to demonstrate a clear reduction in post-operative complication rates compared to the open surgical series. Laparoscopic and robotic radical cystectomy show a reduction in blood loss, in-hospital stay and transfusion rates but a longer operative time, while open radical cystectomy is typically associated with a shorter operative time but with a longer in-hospital admission and possibly a higher rate of high grade complications.

Keywords:
Radical cystectomy
Robotic
Laparoscopy
Perioperative outcomes
Complications
Resumen

La cistectomía radical y disección de los ganglios linfáticos regionales es el tratamiento estándar para el cáncer vesical músculo invasivo localizado y no músculo-invasivo de alto riesgo, y representa uno de los principales procedimientos quirúrgicos urológicos. El abordaje quirúrgico abierto es todavía ampliamente adoptado, aunque en las últimas 2 décadas se han hecho esfuerzos con el fin de evaluar si los procedimientos mínimamente invasivos, ya sean laparoscópicos o asistidos por robot, podrían mostrar un beneficio en comparación con la técnica estándar. La cistectomía radical abierta se asocia con una alta tasa de complicaciones, pero los datos de la serie quirúrgica laparoscópica y robótica no lograron demostrar una clara reducción en las tasas de complicaciones postoperatorias en comparación con la serie quirúrgica abierta. La cistectomía radical laparocópica y robótica muestran una reducción en la pérdida de sangre, las tasas de estancia hospitalaria y de transfusión, pero un mayor tiempo operatorio, mientras que la cistectomía radical abierta se asocia típicamente con un tiempo operatorio más corto, pero con un ingreso más largo en el hospital y, posiblemente, una mayor tasa complicaciones de alto grado.

Palabras clave:
Cistectomía radical
Robótica
Laparoscopia
Resultados perioperatorios
Complicaciones

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