Perioperative Systemic Inflammatory Response following Robot-Assisted Laparoscopic Cystectomy vs. Open Mini-Laparotomy Cystectomy: A Prospective Study

Abstract

Introduction: Surgeries, such as radical cystectomy (RC), induce a systemic inflammatory response (SIR). SIR plays an important role in controlling the human immune system. This study aims at comparing the SIR in robot-assisted laparoscopic cystectomy (RALC) to open mini-laparotomy cystectomy (OMC) with a urinary diversion (UD). Comparison was based on immunologic markers of SIR, thus quantifying the degree of tissue trauma. Materials and Methods: Forty-two male patients underwent RC with an ileal conduit. Either OMC RC (OMC; n = 20), RALC with extracorporeal UD (RALC-EUD; n = 13), or RALC with intracorporeal UD (RALC-IUD; n = 9) was performed. Blood samples were obtained preoperatively (PREOP), immediately after surgery (POD0), 24 (POD1) and 48 h (POD2) postoperatively. Clinical parameters were collected from medical records. Results: Estimated blood loss and blood transfusion volume was higher in OMC (p's < 0.001). The operative time was longer in RALC groups (p < 0.001). On POD0, interleukin (IL)-6 showed significant lower level in RALC-IUD compared to OMC (p = 0.016). IL-10 level was higher at POD0 (p = 0.029) and POD1 (p = 0.038) in OMC vs. RALC-EUD. MCP-1 levels for RALC-IUD were significantly lower compared to RALC-EUD (p = 0.027). Conclusions: This study found that postoperative SIR was overall less pronounced in RALC, thus depicting reduced tissue trauma. No major clinical differences between RALC-IUD and -EUD were found.

Comparison of 2-Year Oncological Outcome and Early Recurrence Patterns in Patients with Urothelial Bladder Carcinoma Treated with Open or Robot-Assisted Radical Cystectomy with an Extracorporeal Urinary Diversion

“…Regarding RARC, only recently 2 randomized trials reported similar oncological survival outcomes when compared to ORC [7,8]. Regarding laparoscopic RC, sufficient data from randomized trials comparing laparoscopic RC and ORC is scarce, similar oncological survival may be anticipated as well [20][21][22].…”

“…Further, whether RARC adds advantages regarding other factors, for example, perioperative systemic inflammatory response is currently under investigation [7]. As far as oncological endpoints are concerned, RARC is reported to provide non-inferior positive surgical margin rate and lymph node yield [4,3].…”

Systemic inflammatory response in robot-assisted and laparoscopic surgery for colon cancer (SIRIRALS): study protocol of a randomized controlled trial

“…In benign and malignant abdominal surgery, the immunological stress response has been studied in other closely related surgical specialities such as gynaecology and urology. However, most studies investigate the surgical stress response in robot-assisted versus open surgery, which is not comparable with this study as there is significantly more trauma with open surgery compared to minimally invasive surgery [ 10 , 37 – 40 ]. It is a common conclusion in many studies that robot-assisted surgery initiates a lower stress response.…”

“…To date, no randomized controlled trials comparing the systemic or peritoneal inflammatory response in colon cancer surgery performed by robot-assisted or laparoscopic methods has been published. A decreased systemic inflammatory response is associated with a lower risk of surgical complications and improved long-term oncological outcomes [ 10 ]. This response is due to a cascade of neuroendocrine, metabolic and immunological factors.…”

Comparing different pneumoperitoneum (12 vs. 15 mmHg) pressures with cytokine analysis to evaluate clinical outcomes in patients undergoing robotic‐assisted laparoscopic radical cystectomy and intracorporeal robotic urinary diversion

“…Indeed, alterations in serum 8 and peritoneal exudate cytokine levels 9 have been associated with ileus, suggesting a relationship for further investigation. In this regard, previous studies have shown a reduction in proinflammatory cytokines and an increase in anti‐inflammatory cytokines in robot‐assisted cystectomy and abdominal surgery, 10,11 associated with a decrease in tissue damage and associated cytokine storm 12,13 . Furthermore, low‐pressure robotic surgery has been shown to improve patient outcomes and is associated with a decrease in surgical injury 14 …”