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Influence of Laparoscopic Access in Cancer -Specific Mortality of Patients with pTa-2pN0R0 Bladder Cancer treated with Radical Cistectomy”

Journal Club CAU (June 2019)

Comment on:

Subirá-Ríos DHerranz-Amo FRenedo-Villar TMoralejo-Gárate MDel Pozo-Jiménez GBueno-Chomón GRodríguez-Fernández E, et al. Influence of laparoscopic access in cancerspecific mortality of patients with pTa-2pN0R0 bladdercancer treated with radical cistectomy. Actas Urol Esp. 2019 Jun;43(5):241-247. doi: 10.1016/j.acuro.2019.01.001.

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 (IQR 27.75–122) months. Patients with laparoscopic access presented a significantly higher ASA index (p = 0.0001), a longer time between TUR and cystectomy (p = 0.04), a lower rate of intraoperative transfusion (p = 0.0001), a lower pT stage (p = 0.002) and a lower incidence of infection associated with surgical wounds (p = 0.04). 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 = 0.007). 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.

Comments:

I hope you also enjoy reading the Volume 43, Issue 5 of Actas Urológicas Spañolas and make objective comments of one of the papers [1].

Retrospective studies are well known as a bias plant; however, they can be central in delineating hypothesis and help in identifying patterns and designing prospective studies [2].

When comparing different surgical accesses, it is vital to recognize that independent of surgical access the oncological precepts are guaranteed.

Among many concerns recognized by authors, balancing the follow-up of compared groups is an essential part. Reader should be cautious with the fact that, despite any justification, the median follow-up of the series was 80 (IQR 27.50–137.50) in the open access group, and 43 (IQR 22–73.50) months (p = 0.0001) in the laparoscopic group.

Also important to avoid overstatements, which was well illustrated by the authors’ conclusions that in their data it appears that “laparoscopic access does not have a negative impact on cancer-specific survival.” 

References

1- Subirá-Ríos DHerranz-Amo FRenedo-Villar TMoralejo-Gárate MDel Pozo-Jiménez GBueno-Chomón GRodríguez-Fernández E, et al. Influence of laparoscopic access in cancerspecific mortality of patients with pTa-2pN0R0 bladdercancer treated with radical cistectomy. Actas Urol Esp. 2019 Jun;43(5):241-247. doi: 10.1016/j.acuro.2019.01.001.

2- Abbott KVBarton FBTerhorst LShembel A. Retrospective Studies: A Fresh Look. Am J Speech Lang Pathol. 2016 May 1;25(2):157-63. doi: 10.1044/2016_AJSLP-16-0025.

Prof. Dr. Leonardo O. Reis MD MSc PhD
Professor Livre Docente Urologia
Produtividade Pesquisa CNPq
UroScience / Urology / Oncology
University of Campinas, Campinas, SP, Brasil
reisleo@unicamp.br