Comparison of Open Radical Cystectomy vs Robot-Assisted Radical Cystectomy Perioperative Outcomes and Complications at a Single Center: An Analysis of Matched Pairs

Yıl 2023, , 61 - 68, 31.05.2023

Harun Özdemir , Emin Taha Keskin , Merve Şam Özdemir , Metin Savun , Halil Lütfi Canat , Abdülmüttalip Şimşek

https://doi.org/10.54233/endouroloji.20231502-1290426

Öz

Objective: The standard curative treatment for non-metastatic high-risk non-muscle-invasive and muscle-invasive bladder cancer is regional pelvic lymphadenectomy (PLND) combined with radical cystectomy. The most prefered surgical procedure is an open radical cystectomy (ORC). However, there are significant risks related to this surgical procedure. Robot-assisted radical cystectomy (RARC), one of the minimally invasive surgical procedures, has been demonstrated to reduce surgical morbidity and boost recovery. In this study, we examined the postoperative complications and outcomes of patients who underwent RARC and ORC for bladder cancer in our clinic using matched pair analysis.

Material and Methods: Between January 2021 and February 2023, datas of radical cystectomy patients were collected retrospectivelly at our clinic. Twenty patients who underwent RARC and forty patients who underwent ORC were matched at a ratio of 1:2 for age (± 2 years), gender, clinical TNM stage, and urinary diversion (ileal conduit or orthotopic neobladder) during the same period. The outcomes and complications of perioperative and postoperative procedures have been compared.

Results: There was no difference in preoperative data between the two groups. The RARC group had found significantly longer operative times (307.5 versus 391.7 minutes; P=0.001). Patients with RARC group had significantly lower bood-loss (P=0.001) and required less intraoperative blood transfusions (P=0.023). ICU stays were significantly longer in ORC (p =.047). The rates of mild Clavien complications were found to be similar between groups in the postoperative first 90 days. Open surgery was found to be associated with a significantly higher incidence of major (clavien 3-5) complications (p =.042). The 90-day mortality rates for RARC and ORC were found to be 0% and 7.5%, respectively. There was no difference in pathological outcomes between the two groups.

Conclusion: Our initial experience with RARC has demonstrated its safety and practicability, with comparable pathology outcomes, reduction of perioperative blood loss, and advances in 90-day mortality, when compared to ORCs with more years of experience.

Anahtar Kelimeler

Bladder cancer, Complication, Robot-assisted radical cystectomy

Tek Merkezde Açık Radikal Sistektomi ile Robot Yardımlı Radikal Sistektominin Perioperatif Sonuçları ve Komplikasyonlarının Karşılaştırılması: Eşleştirilmiş Çift Analizi

Öz

Amaç: Metastatik olmayan yüksek riskli kasa invazif olmayan ya da kasa invazif mesane kanserinde standart küratif tedavi yöntemi bölgesel pelvik lenfadenektomi (PLND) ile birlikte radikal sistektomidir. Açık radikal sistektomi (ARS), birincil tedavi şeklidir, fakat bu cerrahi yöntem önemli riskler taşımaktadır. Minimal invazif cerrahi tekniklerinden robotik cerrahinin uygulanmasıyla cerrahi morbiditeyi en aza indirmek ve daha hızlı iyileşme gösterilmiştir. Bu çalışmada amacımız kendi kliniğimizde mesane kanseri nedeniyle robot yardımlı radikal sistektomi (RYRS) ve ARS uygulanan hastaların eşleştirilmiş çift analizi kullanarak komplikasyonlar ve perioperatif sonuçlarını karşılaştırmaktır.

Gereç ve Yöntemler: Kliniğimizde Ocak 2021 - Şubat 2023 tarihleri arasında radikal sistektomi hastaların verileri retrospektif olarak elde edildi. RYRS uygulanan 20 hasta, aynı dönemde yaş (± 2 yaş), cinsiyet, klinik TNM evresi ve üriner diversiyon (ileal konduit veya ortotopik yeni mesane) açısından 1:2 oranında ARS uygulanan 40 hasta ile eşleştirildi. Perioperatif, postoperatif sonuçlar ve komplikasyonlar karşılaştırıldı.

Bulgular: Her iki grupta preoperatif veriler açısından fark yoktu. Ameliyat süresi RYRS grubunda anlamlı olarak daha uzundu (307,5’e karşılık 391,7 dakika; P=0.0001). RYRS’de önemli ölçüde daha düşük kanama miktarı (P=0.001) ve daha az intraoperatif kan transfüzyonu (P=0.023) izlendi. Yoğun bakımda kalış süreci ARS’de anlamlı olarak daha yüksek izlendi ( P=0.047). Gruplar arasında 90 günlük minör (clavien 1-2) komplikasyon oranları benzer izlendi. Majör (clavien 3-5) komplikasyonlar açık cerrahide anlamlı şekilde daha fazla görüldü (P=0.042). 90 günlük mortalite oranı, RYRS ve ARS için sırasıyla %0’a karşılık %7.5 idi. Her iki grup arasında önemli patolojik sonuçlar açısından fark görülmedi.

Sonuç: RYRS ile ilk deneyimlerimiz, daha yüksek ARS deneyimiyle karşılaştırıldığında bile benzer patolojik sonuçlar, perioperatif kan kaybını önleme ve 90 günlük mortalite iyileştirmeleri ile güvenli ve uygulanabilir olduğunu göstermiştir.

Anahtar Kelimeler

Komplikasyon, Mesane kanseri, Robot yardımlı radikal sistektomi

Kaynakça

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