Robot-assisted cystectomy (RAC) is the terra incognita and a stumbling block in the tactics of treatment for muscle invasive bladder cancer (MIBC) is to ensure a balance of oncological radicality and quality of life in patients with MIBC, its importance in the organ-sparing treatment of the latter requires investigation and assessment.

OBJECTIVE

To assess the results of organ-sparing surgical treatment for MIBC with the Da Vinci robotic system in a surgical center.

SUBJECTS AND METHODS

The experience in treating 24 patients with MIBC (CT_2a—bN₀M₀), grade 1—2 tumor anaplasia, who had undergone RAC in 2012—2020, was analyzed. The patients’ mean age was 63.8±6.2 years. The inclusion criteria were a single bladder tumor with its sizes allowing resection at a distance of 2 cm from the tumor; the absence of regional and distant metastases; and low- and moderate-grade tumor anaplasia. The operations were performed in 3 steps: 1) urethrocystoscopy and ureteral stenting, if indicated; 2) RAC with transvesical transillumination; and 3) extended pelvic lymphadenectomy. Conversions or intraoperative complications were not observed.

RESULTS

The surgery duration was 151.2±20.6 minutes; the volume of blood loss was 89.3±27.9 ml. The length of hospital stay was 9.7±2.9 bed days. According to the Clavien-Dindo classification, the general complications of surgery were 5.9%. Grade I complications that had occurred in 7% of cases were not included in the investigation. An elective histological examination could not detect a positive surgical margin (PSM) in any case. The median follow-up was 62.7±19.1 months (range, 8—86 months). During the follow-up period, 6 (25%) patients were diagnosed with recurrent MIBC without invasion into the muscle layer. The systemic progression of the tumor process (distant metastases) was detected in 5 (20.8%) patients. The five-year overall, tumor-specific, and relapse-free survival rates were 79.2%, 91.6% and 45.8%, respectively.

CONCLUSION

The robotic access is a worthy alternative to the open one in the surgical treatment of MIBC; however, it requires careful selection of patients. The advantage of RAC is the ability to achieve satisfactory functional and oncological results in the presence of minimal surgical trauma, which also reduces the length of hospital stay for patients. RAC is an optimal surgical approach in the organ-sparing surgery of bladder cancer.