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

INTRODUCCIÓN: Existen muy pocos estudios que comparen la prostatectomía radical abierta (PRA) con la prostatectomía radical laparoscópica (PRL). OBJETIVOS: Comparar el tiempo quirúrgico, las complicaciones postoperatorias y la estancia hospitalaria en los pacientes con cáncer de próstata clínicamente localizado tratados mediante PRA y PRL. MATERIAL Y MÉTODOS: Comparación de dos cohortes (312 con PRA y 206 con PRL) entre 2007 y 2015. Las complicaciones postoperatorias se recogieron siguiendo las recomendaciones de las guías clínicas de la EAU y se agruparon según la clasificación de Clavien-Dindo. Para el contraste de variables cualitativas se utilizó el test Chi-cuadrado y ANOVA para las cuantitativas. Análisis multivariable mediante regresión logística para variables dependientes cualitativas y mediante regresión lineal para las variables dependientes continuas. RESULTADOS: La mediana de duración fue de 3:05 horas para la PRA y de 4:35 para la PRL (p = 0,0001). El 26,4% de pacientes presentaron alguna complicación en el postoperatorio. El 31,2% de PRA y el 19,3% de PRL (p = 0,003). La mediana de estancia fue de 4 días. En el grupo de PRA fue de 4 días, mientras que en el de PRL fue de 3 (p = 0,008). La PRL (p = 0,0001), la realización de linfadenectomía (p = 0,02) y la conservación neurovascular (p = 0,01) fueron factores predictores independientes de prolongación del tiempo quirúrgico. La PRL fue un factor protector independiente de complicaciones (OR = 0,48 p = 0,007). El tipo de prostatectomía no influyó en la estancia hospitalaria. CONCLUSIONES: La prostatectomía laparoscópica consumió mayor tiempo quirúrgico, presentó menor porcentaje de complicaciones y no influyó en la estancia hospitalaria

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

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.

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

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

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

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 / Influence of laparoscopic access in cancer-specific mortality of patients with pTa-2pN0R0 bladder cancer treated with radical cistectomy

Introducción y objetivo: La cirugía mínimamente invasiva representa un abordaje quirúrgico atractivo en la cistectomía radical. Sin embargo, a la espera de estudios definitivos todavía es controvertido el efecto que pudiera tener en los resultados oncológicos. El objetivo de este estudio es evaluar el efecto del abordaje laparoscópico sobre la mortalidad cáncer-específica. Material y método: Estudio de cohortes retrospectivo de dos grupos de pacientes en estadio pT0-2pN0R0 sometidos a cistectomía radical abierta (CRA) (n = 191) y laparoscópica (CRL) (n = 74). Se realizó un análisis mediante regresión de Cox para identificar primero las variables predictoras y posteriormente las variables predictoras independientes relacionadas con la supervivencia. Resultados: El 90,9% fueron varones; la mediana de edad fue de 65 años y la mediana de seguimiento, de 65,5 (IQR 27,75-122) meses. Los pacientes con acceso laparoscópico presentaron de forma significativa un mayor índice ASA (p = 0,0001), un mayor tiempo entre la resección transuretral (RTU) y la cistectomía (p = 0,04), una menor tasa de transfusión intraoperatoria (p = 0,0001), un menor estadio pT (p = 0,002) y una menor incidencia de infección asociada a herida quirúrgica (p = 0,04). Al analizar los distintos factores de riesgo asociados a mortalidad cáncer-específica, solo encontramos el abordaje mediante CRA frente a CRL como factor predictor independiente de mortalidad cáncer-específica (p = 0,007). El acceso abierto a la cistectomía multiplicó el riesgo de mortalidad por 3,27. Conclusiones: En nuestra serie, cuando limitamos los distintos factores identificados asociados a mortalidad cáncer-específica analizando pacientes pT0-2N0R0, el abordaje laparoscópico no representa un factor de riesgo frente al abordaje abierto

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 65 years 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

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.

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.

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

Introducción y objetivo: El principal objetivo del estudio fue establecer la seguridad oncológica del abordaje laparoscópico en la cistectomía radical de tumores uroteliales de alto riesgo no órgano-confinados. Material y métodos: Estudio de cohortes retrospectivo de 216 cistectomías estadio patológico pT3-4 intervenidos entre 2003 y 2016; con acceso abierto (CRA, n = 108) y laparoscópico (CRL, n = 108). Resultados: Ambos grupos tuvieron similares características patológicas, excepto en grado G3 de la RTU, mayor número de linfadenectomías y con mayor pN+, y mayor número de quimioterapia adyuvante en el grupo de CRL. La mediana de seguimiento de la serie fue de 15 (IQR: 8-10,5) meses. Recidivó el 68,1% de la serie, sin diferencias entre ambos grupos (p = 0,11). La estimación de las diferencias para la supervivencia cáncer específica fue mayor en el grupo de CRL (p = 0,03), al igual que la supervivencia global (p = 0,009). No existieron diferencias entre ambos grupos en estimación de supervivencia libre de recidiva (p = 0,26). El tipo de acceso quirúrgico (p = 0,03), el estadio pTpN (p = 0,0001) y la administración de quimioterapia adyuvante (p = 0,003) se relacionaron con la mortalidad cáncer específica (MCE) en el análisis univariante. Solo el estadio pTpN (p = 0,0001) y la no administración de quimioterapia adyuvante (p = 0,003) se comportaron como factores predictores independientes de MCE. Conclusión: El tipo de acceso quirúrgico a la cistectomía (CRA vs. CRL) no influyó en la MCE. La afectación ganglionar y la ausencia de quimioterapia adyuvante se identificaron como factores predictores de MCE. Nuestro estudio avala la seguridad oncológica del abordaje laparoscópico de la cistectomía en los pacientes con tumores vesicales musculoinvasivos localmente avanzados

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

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.