Comparative analysis of perioperative results of open and laparoscopic radical cystectomy with the formation of ileoconduit

Abstract

Introduction. Minimally invasive radical cystectomy replicates principles of open surgery and has similar oncological outcomes. In addition, it may reduce the incidence of early postoperative complications and confer earlier patients’ recovery. Materials and methods. We prospectively selected 44 cases, 40 men (90,9%) and 4 women (9,1%), from of 148 patients who undergone radical cystectomy (RCE) with urine derivation into the Briсker’s ileum-conduit during the period from 2017 to 2020. The average age of patients was 62.8± 10,1 years. All the patients included in our study were assigned into 2 groups. Group I consisted from 22 (50%) patients who underwent open RCE and 22 (50%) patients who underwent laparoscopic RCE were included in group II. Results. Median of surgery time was 257 (200-360) min in group I and 290 (160-470) min in group II, р=0,04. Median of estimated blood loss was 218 (50-700) ml in group I and 193 (100-500) ml in group II, р=0,04. Blood transfusions were required in 3 (13,6%) patients of group I. Median length of stay was 16 days in group I and 14 days in group II, р=0,05. There were 25 (56,8%) complications recorded over the 30-day’s period. Eight (36,1%) patients of group I and in 6 (27,2%) patients of group II (р=0,33) had a complications grade I-II according to Clavien-Dindo classification. Grade III-IV ClavienDindo had 7 (31,8%) patients from group I and 4 (18,2%) patients from group II (p=0,04). There were 13 (29,5%) complications within 31-90 days after surgery. The grade I-II Clavien-Dindo were registered in 5(22,7%) patients from group I and in 4 (18,1 %) patients from group II (p=0,47). Grade III-IV Clavien-Dindo observed in 2 (9,1%) patients from group I and 2 (9.1%) patients from group II (р=0,68). Readmission rate within the 90 days after surgery was 10.4% among the patients of group I and 7,7% among patients of group II. General 90-day mortality rate was 6.9%: 1 (4,8%) patient from group I and 2 (9,0%) patients from group II (p=0,48). Conclusion. The laparoscopic approach for RCE has a longer surgery duration but provides a lower blood loss and of Clavien-Dindo grade III-IV complications rate during the 30 days after surgery in comparison with open surgery.