Comparing peri-operative complications between laparoscopic and robotic radical cystectomy for bladder cancer

Bladder Cancer

Arora A, et al. J Endourol 2020.


BACKGROUND: Minimally invasive cystectomy is being increasingly performed however, data comparing laparoscopic radical cystectomy (LRC) and robotic radical cystectomy (RRC) is scarce. We compared 30-day and 90-day Clavien-Dindo Classification(CDC) complications between patients undergoing LRC and RRC at our centre.

MATERIALS AND METHODS: We retrospectively evaluated 300 patients who underwent minimally invasive radical cystectomy from January 2007 to July 2019 and grouped them into LRC (112 patients) and RRC (188 patients). We compared the 2 groups for demographic variables, peri-operative characteristics and 30-day and 90-day CDC overall, minor and major complications. Multivariable logistic regression analysis was performed to identify variables which predict peri-operative complications.

RESULTS: The 2 groups were comparable for the duration of surgery (270 min in LRC vs 265 min in RRC) and rate of conversion to open surgery. The RRC cohort had a higher estimated blood loss (675 ml vs 500 ml, p=0=0.006), but the two groups had a comparable need for intra-operative transfusion. Patients undergoing RRC also had a shorter duration of hospital stay (13 vs 14 days, p<0.001). There was no difference between the 2 groups for 30-day and 90-day CDC overall, minor and major complications. The incidence of re-hospitalization within 30 days (p=0.1) and surgical re-intervention (p=0.5) was also comparable between the 2 groups. On multivariable logistic regression analysis, approach to cystectomy (RRC vs LRC) was not a significant predictor of 30-day CDC overall and major complications.

CONCLUSION: LRC was associated with lesser EBL while the hospital stay was shorter in patients undergoing RRC. The two approaches were comparable to each other for 30-day and 90-day CDC overall, minor and major complications. The choice between the 2 approaches should depend on availability and surgeon experience and preference, rather than any specific peri-operative parameter.