Lower blood loss, fewer transfusions with robot-assisted cystectomy

Blood loss and transfusions after radical cystectomy for bladder cancer decline significantly with robot-assisted versus open surgery, a review of medical records showed.

Median blood loss after robot-assisted radical cystectomy was 409 mL compared with 799 mL with open radical cystectomy. More than half of patients required blood transfusions after open cystectomy compared with fewer than 20% of patients after robot-assisted surgery, as reported yesterday.

“Since blood transfusion is costly and both blood loss and transfusion are associated with adverse outcomes after surgical procedures, these results may influence the comparative effectiveness and cost-effectiveness of robot-assisted radical cystectomy and open radical cystectomy,” said senior author Daniel Barocas, MD, of Vanderbilt University, Nashville, TN.

The findings came from an analysis of prospectively collected data on 249 consecutive bladder cancer patients who underwent radical cystectomy between December 2007 and September 2010. The study population consisted of 58 patients who had robot-assisted surgery and 191 who had open surgery.

The primary outcomes of the analysis were blood loss and perioperative transfusion.

The difference in blood loss was statistically significant (pp

The two groups of patients did not differ significantly with respect to postoperative complications, surgical margins, or lymph node count. Multivariate analysis showed that robot-assisted radical cystectomy was associated with a greater than 90% reduction in the odds ratio for blood loss and transfusion versus open cystectomy.