Clinical Application Of Robotic Assisted Radical Cystectomy+Mainz Ⅱ

Objective:To compare the clinical effects of robotic assisted radical cystectomy(RARC)and laparoscopic radical cystectomy(LRC)for bladder cancer,and analyze the difference between in intracorporeal urinary diversion(ICUD)and extracorporeal urinary diversion(ECUD)in Mainz II after RARC,to explore the feasibility and security of ICUD.Methods: 127 patients with bladder cancer who underwent Leonardo da Vinci robot assisted or laparoscopic radical cystectomy(RARC/LRC)+Mainz II in the Second Hospital of Lanzhou University from January 2020 to December 2022 were selected as the study subjects.All patients were divided into RARC group and LRC group according to the surgical method.The general information,perioperative conditions,pathological results,postoperative complications,short-term efficacy,and quality of life of the patients in the two groups were compared,as well as the clinical data of ICUD and ECUD,two different urinary diversion methods,for Mainz II surgery after RARC were statistically analyzed.Results: All 127 patients were successfully operated,and there was no conversion to open.The general preoperative data of patients in the RARC and LRC groups were comparable,and the difference was not statistically significant(P>0.05).The median operative time in the RARC and LRC groups was 452 min and 386 min respectively,the median blood loss was 365 m L and 405 m L,and the blood transfusion rate was 16.7%and 38.8%,the median postoperative feeding time was the 4th and 5th days after operation,the median drainage tube removal time was the 9th and 10 th days,the median postoperative hospitalization time was 12 and 14 days,and the median total hospitalization cost was 109493 yuan and 66040 yuan,the differences were statistically significant(P<0.05).There was no statistically significant difference in postoperative body temperature between the RARC and LRC groups(P=0.360).The median number of lymph node dissection in the RARC and LRC groups was 12 and 9,respectively,with a statistically significant difference(P=0.028).However,there was no statistically significant difference between the two groups in terms of postoperative pathological staging,lymph node positive rate,and surgical margin positive rate(P>0.05).There was no statistically significant difference in the incidence of early complications,Clavien-Dindo grade,and the incidence of mild(Clavien-Dindo grade≤ 2)and severe complications(Clavien-Dindo grade ≥ 3)between the two groups of RARC and LRC(P>0.05).The incidence of long-term complications in the RARC group and the LRC group was 28.6% and 48.2%,the incidence of minor complications was 23.8% and 29.4%,and the incidence of severe complications was 4.8% and 18.8%,respectively.There was a statistically significant difference in the incidence of longterm and severe complications between the two groups(P<0.05).Univariate logistic regression analysis found that preoperative neoadjuvant chemotherapy,blood loss,blood transfusion rate,postoperative food intake time,and postoperative hospital stay had statistically significant effects on postoperative complications after cystectomy(P<0.05).Multivariate logistic regression analysis found that preoperative neoadjuvant chemotherapy would reduce the risk of postoperative complications(OR=0.357,95% CI: 0.137-0.933,P=0.036);Prolonged hospital stay after surgery will increase the risk of complications(OR=1.162,95% CI: 1.052-1.284,P=0.003).The area under the curve(AUC)of the ROC curve analysis model for predicting complications after cystectomy was 0.754(95% CI: 0.669-0.839,P=0.000),with a maximum Jordan index of 0.411,a corresponding sensitivity of 80.2%,and a specificity of 60.9%.The readmission rates at 90 days after surgery in the RARC and LRC groups were 19% and 36.5%,respectively,with a statistically significant difference(P=0.045).There was no statistically significant difference between the two groups in terms of postoperative urinary control rate and oncological results(P>0.05),while the RARC group was superior to the LRC group in terms of quality of life.The median quality of life scores of the two groups were 45 and 41,respectively,with a statistically significant difference(P=0.001).In the subgroup analysis of Mainz II surgical procedures after RARC,the median surgical time in the ICUD group and the ECUD group was 465 minutes and 444 minutes,respectively.The surgical time in the ICUD group was longer than that in the ECUD group,with a statistically significant difference(P=0.013).The blood loss in the ICUD group and the ECUD group was(333.18± 35.23)ml and(377.74 ± 57.24)ml,respectively,with a statistically significant difference(P=0.020).The median postoperative feeding time in the ICUD and ECUD groups was the 3rd and 4th postoperative days,respectively.The postoperative feeding time in the ICUD group was earlier than that in the ECUD group,with a statistically significant difference(P=0.015).There was no significant difference in other clinical data between the two groups(P>0.05).Conclusion: 1.Both RARC+Mainz II and LRC+Mainz II can achieve good clinical efficacy in the treatment of bladder cancer.Compared to traditional LRC,RARC has advantages in perioperative(intraoperative blood loss,blood transfusion rate,postoperative feeding time,drainage tube removal time,and hospital stay),pathological results(number of lymph node dissection),long-term complications,and quality of life.2.Both ICUD and ECUD for Mainz II surgery after RARC are safe and feasible,with less intraoperative blood loss and shorter postoperative feeding time.This is beneficial to improving intraoperative safety and accelerating postoperative rehabilitation,and more importantly,reflects the value of robotic assistance.