An anesthetic perspective on transoperative complications in open versus robot-assisted radical cystectomy: a five-year retrospective study
Uma perspectiva anestésica sobre complicações transoperatórias em cistectomia radical aberta versus assistida por robô: um estudo retrospectivo de cinco anos
Sérgio Luiz do Logar Mattos, Ronaldo Damião, Fabrício Borges Carrerette, Aretha Paes de Lima Carneiro, Ian Maia Fontes
Abstract
Background
Radical cystectomy remains the standard treatment for invasive bladder cancer, yet it carries significant anesthetic risks. While robot-assisted surgery has gained popularity, data
comparing its anesthetic implications to those of open surgery are limited. This study aimed to
compare the incidence of transoperative complications between the two techniques.
Methods
We retrospectively analyzed 44 patients who underwent open (n = 29) or robot-assisted (n = 15) radical cystectomy in a university hospital between 2019 and 2024. Data were collected on American Society of Anesthesiologists (ASA) physical status, intraoperative hemodynamic parameters, ventilatory complications, additional postoperative opioid requirements, Intensive Care Unit (ICU) stay, and total length of hospital stay. Correlations between blood loss, transfusion requirements, and hemodynamic variables were evaluated.
Results
The robotic cystectomy group experienced less intraoperative bleeding (mean of 410 ± 185 mL vs. 662.5 ± 210 mL; p = 0.002), but no significant reduction in transfusion requirements (95% CI not reported; p = 0.110) despite a strong correlation between bleeding volume and need for transfusion (r = 0.78; p < 0.001). Opioid consumption was significantly higher in the open cystectomy group (75.9% vs. 33.3%; p = 0.004). There was no significant difference in intraoperative hypotension, vasoactive drug use, ventilatory complications, in-hospital mortality, ICU stay, or total hospital stay (p > 0.05 for all). However, the small sample size limits the precision of these estimates.
Conclusion
While robot-assisted radical cystectomy was associated with reduced blood loss and lower additional postoperative opioid use, our small retrospective sample did not identify significant differences in intraoperative hemodynamic parameters or major complications. The surgical technique had no impact on in-hospital mortality.
Keywords
Resumo
Introdução
A cistectomia radical continua sendo o tratamento padrão para o câncer de bexiga invasivo, embora envolva riscos anestésicos significativos. Enquanto a cirurgia assistida por robô tem ganhado popularidade, há poucos dados comparando suas implicações anestésicas com as da cirurgia aberta. Este estudo teve como objetivo comparar a incidência de complicações transoperatórias entre as duas técnicas.
Métodos
Foi realizada uma análise retrospectiva de 44 pacientes submetidos à cistectomia radical aberta (n = 29) ou assistida por robô (n = 15) em um hospital universitário entre 2019 e 2024. Foram coletados dados sobre o estado físico segundo a American Society of Anesthesiologists (ASA), parâmetros hemodinâmicos intraoperatórios, complicações ventilatórias, necessidade adicional de opioides no pós-operatório, tempo de permanência na Unidade de Terapia Intensiva (UTI) e duração total da internação hospitalar. Foram avaliadas correlações entre perda sanguínea, necessidade de transfusão e variáveis hemodinâmicas.
Resultados
O grupo de cistectomia robótica apresentou menor sangramento intraoperatório (média de 410 ± 185 mL vs. 662,5 ± 210 mL; p = 0,002), mas sem redução significativa na necessidade de transfusão (IC 95% não relatado; p = 0,110), apesar de forte correlação entre volume de sangramento e necessidade de transfusão (r = 0,78; p < 0,001). O consumo de opioides foi significativamente maior no grupo de cistectomia aberta (75,9% vs. 33,3%; p = 0,004). Não houve diferença significativa em hipotensão intraoperatória, uso de drogas vasoativas, complicações ventilatórias, mortalidade hospitalar, tempo de permanência em UTI ou duração total da internação (p > 0,05 para todos). No entanto, o pequeno tamanho da amostra limita a precisão dessas estimativas.
Conclusion
Embora a cistectomia radical assistida por robô tenha sido associada à menor perda sanguínea e ao menor uso adicional de opioides no pós-operatório, nossa pequena amostra retrospectiva não identificou diferenças significativas nos parâmetros hemodinâmicos intraoperatórios ou em complicações maiores. A técnica cirúrgica não teve impacto na mortalidade hospitalar.
Palavras-chave
References
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Submitted date:
03/20/2025
Accepted date:
08/17/2025
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