Perioperative results and quality of life for various methods of urinary diversion after robot-assisted cystectomy

Background. Bladder cancer is one of the leading causes of mortality and morbidity among urologic malignancies. Radical cystectomy remains the “gold standard” of treatment of muscle-invasive and refractory non-muscle invasive forms of the disease. In recent years, robot-assisted radical cystectomy (RARC) has been increasingly adopted as a minimally invasive alternative, offering reduced blood loss and faster recovery times. However, the optimal method of urinary diversion remains a topic of debate.

Aim. To compare perioperative outcomes and quality of life indicators in patients who underwent RARC followed by Bricker ileal conduit or Studer neobladder urinary diversion.

Materials and methods. A retrospective cohort study was conducted involving 83 patients diagnosed with muscle-invasive bladder cancer who underwent RARC with Bricker ileal conduit (66 patients) or Studer neobladder (17 patients) urinary diversion at the Urology Department of the A.S. Loginov Moscow Clinical Research Center from January 2018 to October 2023. Perioperative indicators included operative time, blood loss volume, and length of stay. Complications were classified using the Clavien–Dindo system, and quality of life was assessed with the European Organization for Research and Treatment of Cancer (EORTC QLQ-BLM30) questionnaire at 6 and 12 months post-surgery.

Results. Operative time was longer in the Studer neobladder group (466.18 ± 74.64 minutes) than in the Bricker ileal conduit group (364.92 ± 48.85 minutes; p <0.001). Blood loss volume was also higher in the Studer group (294.12 ± 77.51 mL versus 218.94 ± 105.67 mL; p = 0.002). The rate and severity of complications did not differ between groups (p = 0.78). Six months postoperatively, patients with orthotopic neobladders (Studer) reported higher quality of life scores (p <0.001), but by 12 months, the differences between the groups were no longer significant.

Conclusion. RARC with Studer neobladder is associated with longer operative time. Although the difference in blood loss was statistically significant, this difference in the volume of lost blood has no clinical significance. Complication rates do not differ. Patients with Studer neobladders demonstrated higher quality of life at 6 months post-surgery; however, these differences are no longer apparent at 12 months.

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