Introduction:

The incidence of bladder cancer in the US is estimated to be 81,400 cases in 2020 with 17,980 projected deaths. Over the past decade, the incidence of bladder cancer has decreased annually in the US, as well as in Alabama, our institution’s state. However, the mortality rate from bladder cancer in Alabama has increased over the past five years.  The treatment of muscle invasive bladder cancer (MIBC) can be morbid with significant impact on patient mortality and quality of life. Though data exists regarding the comparable perioperative outcomes between surgical approaches, here we review our institutions operative outcomes between robotic and open cystectomies with the aim to improve patient pre-operative counseling.

Methods:

All patients who underwent radical cystectomy at our institution between January 2014 and June 2019 were retrospectively reviewed. Preoperative demographic data, operative parameters, and perioperative outcomes were collected and analyzed using t-test, chi-square, and Fischer exact statistical measures.

Results:

A total of 185 patients were included in our study, 138 males and 47 females.  Caucasians, African-Americans and Asians  represented 83%, 15%, 2%, respectively.  Mean BMI was 28.42 (range,14.39-47.38).  Former, current, and non-smokers represented 49.8%, 18.95, and 31.3% respectively.  The study population was divided into two cohorts: open and robotic approach. Comparative analysis revealed significant difference in ICU admissions, intra-operative blood loss and inpatient transfusion requirements(Table 1.) At time of collection, 12.7% of patients were reported as deceased. 71 patients (32%) encountered acute complications including, prolonged ileus(7.7%), replacement of nasogastric tube(0.5%), urinary ureteral leak(1.8%), urinary pouch leak or fistula (2.3%), bowel anastomotic leak (0.5%), abscess(2.7%), thromboembolic event (0.9%), wound dehiscence(4.1%), superficial wound infection(1.84%), antibiotic requiring UTI(8.3%), symptomatic lymphocele (0.5%). There was no significant difference in acute complications between the two cohorts. However, there was a significant difference in abdominal wall hernia, new post-operative hydronephrosis and new post-operative renal insufficiency(Table 2.)

Conclusion:

At our institution, surgical approach to radical cystectomy significantly affects certain inpatient variables such as operative time, transfusion requirements and ICU admissions. However, acute and long term complications did not significantly differ between the two cohorts. Future study direction will include further sub-group analysis of a larger study population to help develop an operative risk calculator specific to our institution for improved patient counseling.

Funding: N/A