Propensity Score-Matched Comparison Of Perioperative Outcomes Of Robot-Assisted Radical Cystectomy Versus Laparoscopic Radical Cystectomy

Background: Bladder tumors are one of the most common tumors in urology in China,posing a serious threat to the survival of patients.With the continuous improvement of China’s economy and medical level,the incidence rate of bladder cancer in China is also on the rise.The depth of bladder tumor invasion affects the prognosis of patients.According to the depth of bladder tumor invasion,it can be divided into non muscle invasive bladder cancer(staging includes Tis,Ta,T1)and muscle invasive bladder cancer(staging T2 and above).The treatment of non muscle invasive bladder cancer mainly includes transurethral resection of bladder tumor and bladder perfusion,while the treatment of muscle invasive bladder cancer mainly includes radical cystectomy + pelvic lymph node dissection + urinary diversion.The indications for radical cystectomy include: myometrial invasive bladder tumor T2-T4 a,N0-Nx,M0 and selected high-risk non myometrial invasive cancer patients(such as T1G3,Tis that did not respond to BCG treatment,recurrent non myometrial invasive bladder cancer,bladder non urothelium cancer,etc.).The surgical methods of radical cystectomy include open surgery and minimally invasive surgery,which is also known as laparoscopic surgery,including traditional laparoscopic surgery(LRC)and robot assisted laparoscopic surgery(RARC).Compared to open surgery,laparoscopic surgery has been proven to be safe and effective.Minimally invasive surgery is more and more used in the treatment of bladder cancer clinically with the advantages of less intraoperative bleeding,fewer postoperative complications,and postoperative oncological results similar to open surgery.However,there is currently a lack of evidence to compare these two minimally invasive surgical methods.Our aim is to compare the perioperative results of RARC and LRC,providing reference opinions for doctors and patients,and making the best clinical decisions.Methods: This experiment is a retrospective study.We retrospectively collected clinical data from patients who underwent radical cystectomy from January 2015 to June 2022 in the case database of the First Affiliated Hospital of Nanchang University.The data of 154 patients with RARC and 179 patients with LRC were divided into laparoscopic surgery group(LRC group)and robot assisted laparoscopic surgery group(RARC group)according to the operation mode,and propensity score matching was performed.1:1 propensity score matching(PSM)was performed according to gender,age,age adjusted Charlson’s complication index(CCI),history of neoadjuvant chemotherapy,history of abdominal surgery,smoking history,clinical stage,type of urinary diversion(UD),and hysterectomy and adnexectomy.Summarize the data using descriptive statistics.Multivariate linear and logistic regression models are suitable for evaluating surgical time,high-grade complications(Clavien Dindo grade ≥ III),and infection complications.Results: A total of 333 patients’ clinical data were included,of which 238 patients underwent final analysis and evaluation;119 cases of LRC and 119 cases of RARC.The operation time in the RARC group was approximately 20 minutes longer than in the LRC group.However,the RARC group showed lower rates of30-day high grade complications(9.1% vs.19.6%,P = 0.007)and infectious complications(28.6% vs.38.0%,P = 0.070)compared to the LRC group.Other perioperative outcomes were similar in both groups,and there was no difference in pathological outcomes between the two groups.Conclusions: In this single-center series comparing RARC and LRC,RARC appeared to be a better surgical approach than LRC in terms of short-term postoperative outcomes.Moreover,we need larger sample sizes and more high-quality studies for further improvement and validation.