Transperitoneal vs extraperitoneal radical cystectomy: A systematic review and meta-analysis

Area of Science:

• Urology
• Surgical Oncology
• Evidence-Based Medicine

Background:

• Radical cystectomy (RC) is a complex surgery for bladder cancer with significant morbidity.
• The transperitoneal approach is standard but linked to complications like ileus and infection.
• This study compares transperitoneal RC with the extraperitoneal RC approach.

Approach:

• A systematic meta-analysis was conducted using PubMed, Cochrane Library, and Science Direct.
• Keywords included Radical Cystectomy, Extraperitoneal, and Transperitoneal, up to August 31, 2022.
• Eight studies (3 laparoscopic, 5 open) with 1207 patients were analyzed using Review Manager software.

Key Points:

• The extraperitoneal approach showed a significantly lower incidence of postoperative ileus (p < 0.00001).
• No significant differences were observed in operative time, estimated blood loss, hospital stay, or major complications (Clavien-Dindo Grade 3-5).
• Total infection rates were also comparable between the extraperitoneal and transperitoneal methods.

Conclusions:

• Extraperitoneal radical cystectomy offers a significant benefit by reducing postoperative ileus.
• The choice between extraperitoneal and transperitoneal approaches may depend on minimizing specific complications like ileus.