A comparison of preliminary oncologic outcome and postoperative complications between patients undergoing either open or robotic radical cystectomy

Vol. 42 (4): 663-670, July – August, 2016

doi: 10.1590/S1677-5538.IBJU.2015.0393


ORIGINAL ARTICLE

Antonio Cusano 1, Peter Haddock 1, Max Jackson 1, Ilene Staff 1, Joseph Wagner 1, Anoop Meraney 1

1 Urology Division, Hartford Healthcare Medical Group, Hartford, USA

ABSTRACT

Purpose: To compare complications and outcomes in patients undergoing either open radical cystectomy (ORC) or robotic-assisted radical cystectomy (RRC).
Materials and Methods: We retrospectively identified patients that underwent ORC or RRC between 2003- 2013. We statistically compared preliminary oncologic outcomes of patients for each surgical modality.
Results: 92 (43.2%) and 121 (56.8%) patients underwent ORC and RRC, respectively. While operative time was shorter for ORC patients (403 vs. 508 min; p<0.001), surgical blood loss and transfusion rates were significantly lower in RRC patients (p<0.001 and 0.006). Length of stay was not different between groups (p=0.221). There was no difference in the proportion of lymph node-positive patients between groups. However, RRC patients had a greater number of lymph nodes removed during surgery (18 vs. 11.5; p<0.001). There was no significant difference in the incidence of pre-existing comorbidities or in the Clavien distribution of complications between groups.
ORC and RRC patients were followed for a median of 1.38 (0.55-2.7) and 1.40 (0.58-2.59) years, respectively (p=0.850). During this period, a lower proportion (22.3%) of RRC patients experienced disease recurrence vs. ORC patients (34.8%). However, there was no significant difference in time to recurrence between groups. While ORC was associated with a higher all-cause mortality rate (p=0.049), there was no significant difference in disease-free survival time between groups.
Conclusions: ORC and RRC patients experience postoperative complications of similar rates and severity. However, RRC may offer indirect benefits via reduced surgical blood loss and need for transfusion.

Keywords: Oncology Nursing; Postoperative Period; Robotics; Cystectomy; Urinary Bladder Neoplasms

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