Influence of the laparoscopic approach on cancer-specific mortality of patients with stage pt3-4 bladder cancer treated with cystectomy

Abstract 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  = 0.11). The estimated differences for cancer-specific survival was greater in the LRC group ( p  = 0.03), as was overall survival ( p  = 0.009). There were no differences between either group in estimated recurrence-free survival ( p  = 0.26). The type of surgical approach ( p  = 0.03), pTpN stage ( p  = 0.0001), and administration of adjuvant chemotherapy ( p  = 0.003) were related to cancer-specific mortality (CSM) in the univariate analysis. Only the pTpN stage ( p  = 0.0001), and not giving adjuvant chemotherapy ( p  = 0.003) 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.