Impact of clinical stage on the outcome of laparoscopic radical cystectomy: a prospective cohort study

Abstract
Background
Some authors recommend not to perform laparoscopic radical cystectomy (LRC) for large bulky bladder cancer (BC) as the laparoscopic manipulation will be difficult. As there were no prospective studies focusing on the effect of the tumor stage of BC on the outcome of LRC, the aim of this prospective cohort study was to evaluate the effect of tumor stage on the outcome of LRC.

Results
LRC was completed for 47 patients. All patients were followed for at least 1 year, and there was no recurrence. COPD, DM, hypertension and renal impairment were detected, respectively, in 57.4%, 36.2%, 44.7% and 10.6% of patients. Transitional cell carcinoma and squamous cell carcinoma were found, respectively, in 91.5% and 8.5% of patients. Complications were reported in 29.78% including 29.78% Clavien grade 1, 17.02% grade 2 and 6.38% grade 3. There was no significant difference between cT2 and cT3 in perioperative criteria including demographic features, operative time, estimated blood loss, blood transfusion, pain score, hospital stay and complications. Upon final pathological assessment, 44.68% of patients were upgraded to higher pathological stages. Additional comparison was performed according to pathological stage and revealed no significant difference in the outcome of LRC between pT2 and higher stages except the pain score at first postoperative day which was higher in patients with pT3 stage.

Conclusion
LRC is a feasible and safe technique for both T2 and T3 clinical and pathological stages.