A Critical Analysis of Early Bladder Cancer Recurrence After Laparoscopic Radical Cystectomy
Although laparoscopic radical cystectomy and robotic-assisted radical cystectomy continue to grow in popularity and are successful in the treatment of bladder cancer, they are still considered experimental approaches. Using data collected by the Section of Uro-Technology of the European Association of Urology (ESUT), a team of researchers found that about 5% of patients experienced unexpected relapses of cancer after laparoscopic radical cystectomy, even with favorable pathology. Their results were reported by Albisinni et al in The Journal of Urology.
Currently, most large multicenter studies suggest minimally invasive cystectomy is noninferior in terms of cancer control compared to open radical cystectomy. While open radical cystectomy is the standard of care in the surgical management of muscle invasive and high-risk nonmuscle invasive bladder cancer, the associated risk of death has motivated urologists to examine the feasibility and safety of laparoscopic radical cystectomy and robotic-assisted radical cystectomy. In order to track these data, ESUT has been compiling a large, multicenter, prospective database of patients who have undergone laparoscopic radical cystectomy since 2000, which now includes more than 800 patients across Europe.
Study Findings
In the current study, researchers investigated possible causes for the unexpected early recurrence of cancer. 627 patients met the criteria for analysis and 311 had favorable pathology reports after laparoscopic radical cystectomy pT0–pT2N0R0. Of this group, 27 (4.3%) experienced disease progression during the first 24 months. Most of these patients experienced progression to large tumor volume metastatic disease.
Urothelial cancers are often aggressive and exhibit seeding capabilities. The investigators suggest that the use of pneumoperitoneum, or gas injected into the abdomen during laparoscopic radical cystectomy, may increase the chance of this occurring at distant landing sites through the Batson venous plexus, a network of valveless veins that connect deep pelvic veins with vertebral and thoracic vessels.
According to lead investigator Simone Albisinni, MD, of the Department of Urology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium, “These findings raise important questions concerning the spread of malignant urothelial cells and a possible role of pneumoperitoneum and intermittent insufflations on tumoral hematogenous migration during minimally invasive radical cystectomy.”
Early unexpected recurrences after laparoscopic radical cystectomy in almost 5% of patients, all with favorable pathologic characteristics, raise some doubts about the safety of the laparoscopic approach.
“A role in the development of these relapses may have been played by the pneumoperitoneum. Specifically designed studies are necessary to further investigate the role of pneumoperitoneum in urothelial cancer recurrence,” emphasized Dr. Albisinni.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
