An anesthetic perspective on transoperative complications in open versus robot-assisted radical cystectomy: a five-year retrospective study

IF 1.9 4区医学 Q2 ANESTHESIOLOGY

Brazilian Journal of Anesthesiology Pub Date : 2025-08-28 DOI:10.1016/j.bjane.2025.844674

Sérgio Luiz do Logar Mattos , Ronaldo Damião , Fabrício Borges Carrerette , Aretha Paes de Lima Carneiro , Ian Maia Fontes

{"title":"An anesthetic perspective on transoperative complications in open versus robot-assisted radical cystectomy: a five-year retrospective study","authors":"Sérgio Luiz do Logar Mattos , Ronaldo Damião , Fabrício Borges Carrerette , Aretha Paes de Lima Carneiro , Ian Maia Fontes","doi":"10.1016/j.bjane.2025.844674","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Radical cystectomy remains the standard treatment for invasive bladder cancer, yet it carries significant anesthetic risks. While robot-assisted surgery has gained popularity, data comparing its anesthetic implications to those of open surgery are limited. This study aimed to compare the incidence of transoperative complications between the two techniques.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 44 patients who underwent open (n = 29) or robot-assisted (n = 15) radical cystectomy in a university hospital between 2019 and 2024. Data were collected on American Society of Anesthesiologists (ASA) physical status, intraoperative hemodynamic parameters, ventilatory complications, additional postoperative opioid requirements, Intensive Care Unit (ICU) stay, and total length of hospital stay. Correlations between blood loss, transfusion requirements, and hemodynamic variables were evaluated.</div></div><div><h3>Results</h3><div>The robotic cystectomy group experienced less intraoperative bleeding (mean of 410 ± 185 mL vs. 662.5 ± 210 mL; p = 0.002), but no significant reduction in transfusion requirements (95% CI not reported; p = 0.110) despite a strong correlation between bleeding volume and need for transfusion (<em>r</em> = 0.78; p < 0.001). Opioid consumption was significantly higher in the open cystectomy group (75.9% vs. 33.3%; p = 0.004). There was no significant difference in intraoperative hypotension, vasoactive drug use, ventilatory complications, in-hospital mortality, ICU stay, or total hospital stay (p > 0.05 for all). However, the small sample size limits the precision of these estimates.</div></div><div><h3>Conclusion</h3><div>While robot-assisted radical cystectomy was associated with reduced blood loss and lower additional postoperative opioid use, our small retrospective sample did not identify significant differences in intraoperative hemodynamic parameters or major complications. The surgical technique had no impact on in-hospital mortality.</div></div>","PeriodicalId":32356,"journal":{"name":"Brazilian Journal of Anesthesiology","volume":"75 6","pages":"Article 844674"},"PeriodicalIF":1.9000,"publicationDate":"2025-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Brazilian Journal of Anesthesiology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0104001425000892","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ANESTHESIOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

Radical cystectomy remains the standard treatment for invasive bladder cancer, yet it carries significant anesthetic risks. While robot-assisted surgery has gained popularity, data comparing its anesthetic implications to those of open surgery are limited. This study aimed to compare the incidence of transoperative complications between the two techniques.

Methods

We retrospectively analyzed 44 patients who underwent open (n = 29) or robot-assisted (n = 15) radical cystectomy in a university hospital between 2019 and 2024. Data were collected on American Society of Anesthesiologists (ASA) physical status, intraoperative hemodynamic parameters, ventilatory complications, additional postoperative opioid requirements, Intensive Care Unit (ICU) stay, and total length of hospital stay. Correlations between blood loss, transfusion requirements, and hemodynamic variables were evaluated.

Results

The robotic cystectomy group experienced less intraoperative bleeding (mean of 410 ± 185 mL vs. 662.5 ± 210 mL; p = 0.002), but no significant reduction in transfusion requirements (95% CI not reported; p = 0.110) despite a strong correlation between bleeding volume and need for transfusion (r = 0.78; p < 0.001). Opioid consumption was significantly higher in the open cystectomy group (75.9% vs. 33.3%; p = 0.004). There was no significant difference in intraoperative hypotension, vasoactive drug use, ventilatory complications, in-hospital mortality, ICU stay, or total hospital stay (p > 0.05 for all). However, the small sample size limits the precision of these estimates.

Conclusion

While robot-assisted radical cystectomy was associated with reduced blood loss and lower additional postoperative opioid use, our small retrospective sample did not identify significant differences in intraoperative hemodynamic parameters or major complications. The surgical technique had no impact on in-hospital mortality.

查看原文本刊更多论文

麻醉对开放式与机器人辅助根治性膀胱切除术并发症的影响：一项为期五年的回顾性研究。

背景：根治性膀胱切除术仍然是侵袭性膀胱癌的标准治疗方法，但它具有显著的麻醉风险。虽然机器人辅助手术越来越受欢迎，但将其麻醉意义与开放手术进行比较的数据有限。本研究旨在比较两种技术的手术并发症发生率。方法：我们回顾性分析了2019年至2024年间在某大学医院接受开放（n = 29）或机器人辅助（n = 15）根治性膀胱切除术的44例患者。收集的数据包括美国麻醉医师协会（ASA）的身体状况、术中血流动力学参数、通气并发症、术后额外阿片类药物需求、重症监护病房（ICU）住院时间和总住院时间。评估失血量、输血需求和血流动力学变量之间的相关性。结果：机器人膀胱切除术组术中出血较少（平均为410±185 mL vs. 662.5±210 mL; p = 0.002），但输血需要量没有显著减少（95% CI未报道；p = 0.110），尽管出血量和输血需要量之间存在很强的相关性（r = 0.78;p < 0.001）。开腹膀胱切除术组阿片类药物的消耗明显更高（75.9% vs. 33.3%; p = 0.004）。术中低血压、血管活性药物使用、通气并发症、院内死亡率、ICU住院时间、总住院时间等方面差异均无统计学意义（p < 0.05）。然而，小样本量限制了这些估计的精度。结论：虽然机器人辅助根治性膀胱切除术与减少失血量和减少术后额外阿片类药物使用相关，但我们的小型回顾性样本未发现术中血流动力学参数或主要并发症的显着差异。手术技术对住院死亡率无影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊