Analysis of perioperative, functional and oncological outcomes in patients after robot-assisted radical cystectomy with intracorporeal neobladder formation for bladder cancer

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The purpose of the study was to conduct a descriptive analysis of the results obtained in patients who underwent robot-assisted radical cystectomy and pelvic lymphadenectomy with intracorporeal formation of a urine reservoir for high-grade bladder cancer. Materials and methods. The study included patients after robot-assisted radical cystectomy and pelvic lymphadenectomy with intracorporeal formation of a urine reservoir, operated on at the clinic of JSC MEDSI GC from 2021 to 2024. Results. In 65% of the cases, ileal conduit was formed, and in the remaining 35% of cases, an orthotopic bladder from the segment of the ileum was formed using our own method. The follow-up time averaged 12 months. The median duration of the operation was 360 minutes, blood loss was 300 ml, 9% of the patients required intraoperative blood transfusions, and there were no intraoperative complications. The median hospital stay was 10 days. Ureteral stents were removed on average on the 30th day. In our study, the overall rate of early complications was 61%, but only 13% were severe. Infectious and inflammatory complications were observed in 30%, gastrointestinal – in 23%, and urinary tract complications – in 23%. According to the ICIQUI Short Form, half of the patients have sporadic urine loss (2-3 times a week) and only 8% have permanent urine loss. The positive index of the resection margins was 0%, and an average of 23 lymph nodes were extracted per operation. In 13% of the cases, neoadjuvant therapy chemotherapy/chemotherapy+immunotherapy) was performed before surgery, and in 9% of cases, adjuvant therapy was carried out. With an average follow-up of 12 months, the recurrence rate was 4%, while the recurrence-free survival rate was 96% and the cancer-specific survival rate was 100%. Conclusion. Radical cystectomy in combination with pelvic lymphadenectomy and urinary tract reconstruction with the formation of a continent urinary reservoir or ileal conduit is the method of choice for localized muscleinvasive and non-muscle invasive bladder cancer with a high risk of progression.