| Objective:To compare the short-term clinical outcomes of robot-assisted laparoscopic radical cystectomy and laparoscopic radical cystectomy.To investigate the safety and efficacy of robot-assisted laparoscopic radical cystectomy for the treatment of bladder cancer.Methods:The clinical data of 165 patients who underwent minimally invasive radical cystectomy in our department from March 2015 to September 2022 were retrospectively analyzed and divided into robot-assisted laparoscopic radical cystectomy group(54 patients)and laparoscopic radical cystectomy group(111patients)according to the surgical approach.After 1∶1 matching by propensity score,45 cases each in the robotic and laparoscopic groups were matched for gender,age,BMI,ASA classification,history of previous abdominal surgery,presence of preoperative renal insufficiency,urinary diversion method,operation time,intraoperative bleeding,intraoperative transfusion rate,intraoperative transfusion volume,postoperative transfusion rate,postoperative hospital stay,postoperative pathology type,tumor pathology grading,tumor pathology staging,30-days postoperative complication status,CDC grading,CCI score,survival outcome,and18-month tumor recurrence pattern were analyzed for comparison.Results:All 90 patients matched by propensity score were successfully operated,among which one case in the laparoscopic group was intraoperatively turned open,but there was no statistically significant difference(P>0.05).The preoperative anemia and preoperative albumin level in the general preoperative data of the robotic and laparoscopic groups were statistically different,but the rest of the data were not significantly different and not statistically significant(P>0.05),and the two groups were comparable.The overall 30-days postoperative complication rate was much lower in the robotic group than in the conventional laparoscopic group(48.9%vs80.0%,χ~2=9.504,P=0.002),with a lower complication rate in the robotic group than in the conventional laparoscopic group for unexplained fever(4.4%vs 20%,χ~2=5.075,P=0.024),and the incidence of lower limb venous thrombosis was also lower in the robotic group than in the laparoscopic group(0%vs 20%,χ~2=7.901,P=0.005),and the differences between the two groups were not statistically significant for all other complications[0(0,1)vs 1(1,2),U=675.0,P=0.004],and the robotic group was lower than the conventional laparoscopic group in the 30-days postoperative Clavien-Dindo classification(CDC)(P=0.007),where the robotic group was lower than the conventional laparoscopic group in the incidence of grade II complications(31.1%vs.57.8%,χ~2=6.480,P=0.011).The difference between the two groups was not statistically significant in the incidence of gradeⅠcomplications and serious complications(CDC:grade IIIa～V),and the composite index of complications(CCI)at 30-days postoperatively was also better in the robotic group than in the conventional laparoscopic group[0(0,20.9)vs 20.9(8.7,25.2),U=68 7.5,P=0.007].The number of postoperative hospital days was shorter in the robotic group than in the conventional laparoscopic group[8(7,9)days vs 9(8,11)days,U=667.0,P=0.005].The intraoperative transfusion rate was higher in the robotic group than in the conventional laparoscopic group(40.0%vs 13.3%,χ~2=8.182,P=0.004),and the intraoperative transfusion volume was also higher in the robotic group than in the conventional laparoscopic group[0(0,2)U vs 0(0,0)U,U=749.5,P=0.006].The cost of surgery in the robotic group is higher than in the conventional laparoscopic group[93,000(84,000,99,000)RMB vs 70,000(61,000,78,000)RMB,U=298.0,P<0.001].There was no statistically significant difference between the robotic and conventional laparoscopic groups in terms of intraoperative bleeding,operative time,lymph node dissection rate,number of lymph nodes dissected,positive lymph node dissection rate,number of positive lymph nodes dissected,postoperative transfusion rate,postoperative transfusion volume,postoperative antibiotic administration time,type of postoperative pathology,tumor pathology grade,tumor pathology stage,RFS,CSS,OS,and 18-month recurrence pattern differences(P>0.05).Conclusions:Compared with conventional laparoscopic surgery,robot-assisted laparoscopic surgery has potential advantages in terms of 30-days postoperative complication rate,CDC classification,composite index of complications,and reduction of postoperative hospitalization days,which facilitates faster postoperative recovery and good near-term outcomes.The use of robot-assisted laparoscopic surgery in radical cystectomy is equally safe and effective,and is worth promoting when economic conditions allow. |
