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

Abstract

<b><i>Introduction:</i></b> 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. <b><i>Materials and Methods:</i></b> Forty-two male patients underwent RC with an ileal conduit. Either OMC RC (OMC; <i>n</i> = 20), RALC with extracorporeal UD (RALC-EUD; <i>n</i> = 13), or RALC with intracorporeal UD (RALC-IUD; <i>n</i> = 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. <b><i>Results:</i></b> Estimated blood loss and blood transfusion volume was higher in OMC (<i>p</i>'s < 0.001). The operative time was longer in RALC groups (<i>p</i> < 0.001). On POD0, interleukin (IL)-6 showed significant lower level in RALC-IUD compared to OMC (<i>p</i> = 0.016). IL-10 level was higher at POD0 (<i>p</i> = 0.029) and POD1 (<i>p</i> = 0.038) in OMC vs. RALC-EUD. MCP-1 levels for RALC-IUD were significantly lower compared to RALC-EUD (<i>p</i> = 0.027). <b><i>Conclusions:</i></b> 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.