The oncologic results of laparoscopic radical cystectomy are not (yet) equivalent to open cystectomy

To compare oncologic outcomes in a contemporary series of patients undergoing radical cystectomy (RCX) by the laparoscopic or open approach.

Laparoscopic RCX with extracorporeally constructed urinary diversion is a safe and effective operation for appropriate patients with bladder cancer. Perioperative and functional outcomes are comparable with open surgery. Worldwide experience continues to increase; more than 1000 surgeries have already been performed. Intermediate-term oncologic outcomes appear to be comparable to open approach.

When stage distribution (organ-confined versus nonorgan-confined) and survival rates of laparoscopic and open RCX are cross-checked against surrogate markers (LN+, margin+, distant failure, local recurrence rate, etc.), it becomes easily obvious that the laparoscopic RCX and open cohorts are not identical. To explain the observed discrepancy, there must be a strong selection bias. Data on overall, disease-specific and recurrence-free survival on laparoscopic RCX are still immature compared with the standard of care that must remain in open RCX. To prove the noninferiority of laparoscopic compared with open surgery regarding outcome, multicenter prospective trials are urgently needed. Until then laparoscopic RCX must be considered experimental surgery.