A comparative study of perioperative outcomes in open radical cystectomy, laparoscopic radical cystectomy, and robotic-assisted radical cystectomy.

Abstract

Introduction: Radical cystectomy (RC) is the standard treatment for muscle-invasive and high-risk nonmuscle-invasive bladder cancer. The impact of minimally invasive surgeries (MIS) such as laparoscopic and robot-assisted RC (RARC) on outcomes and morbidity remains debated, especially in India. This study compares perioperative outcomes and complications of open RC (ORC), laparoscopic RC (LRC), and RARC.

Materials and methods: This prospective cohort study included 186 patients who underwent ORC, LRC, or RARC at our institution between October 2013 and April 2024. Preoperative parameters such as age, body mass index (BMI), comorbidities, and chemotherapy status were recorded. Postoperative parameters including operative time, blood loss, return of bowel function, complications, and survival rates were analyzed. Pathological parameters such as stages, lymph node yield, and positive surgical margins were assessed.

Results: The study included 120 ORC, 56 RARC, and 10 LRC patients. The median age was highest in the laparoscopic group (67.4 ± 6.33 years) with a higher BMI (26.22 ± 5.24). Operative time was longest for RARC (414 ± 115.7 min) versus 357.96 ± 60.08 for ORC (P ≤ 0.0001), but blood loss was lowest (413.39 ± 165.55 ml) versus 518.33 ± 171.49 for ORC (P = 0.0001). Return of bowel function was fastest in the RARC group (4.27 + 2.79 days). Complications were highest in the ORC group (70.83%) compared to RARC (51.78%) (P = 0.03). Mean lymph node yield was highest in RARC (24.35 ± 3.06) versus Lap RC (22 ± 2.87) and ORC (19.47 ± 3.56) (P ≤ 0.0001). Overall survival rate was 78.57% for RARC compared to 74.16% for ORC.

Conclusions: Our findings suggest that while RARC provides advantages in blood loss, complication rates, and mean lymph node yield, its longer operative time necessitates further optimization. The study highlights the importance of considering patient-specific factors and regional contexts in surgical approach decisions, with RARC showing promising results.