A comparative study of robot-assisted laparoscopic radical cystectomy combined with urinary diversion: preoperative indicators and survival outcomes analysis at a single center

OBJECTIVE: To compare the preoperative indexes and survival outcomes between da Vinci robot-assisted radical cystectomy (RARC) and laparoscopic radical cystectomy (LRC), and to analyze the clinical differences among the three types of urinary diversion modalities, namely, intracorporeal ileal neobladder (Studer type), Bricker's procedure, and ureterocutaneostomy. METHODS: A total of 194 patients who underwent minimally invasive radical cystectomy in the Department of Urology of the Affiliated Hospital of Zunyi Medical University from January 2010 to December 2024 were retrospectively analyzed and divided into the laparoscopic group (152 patients) and the robotic group (42 patients) according to surgical modalities. Perioperative indexes and survival outcomes of the two groups were compared, and the clinical differences among the three urinary diversion modalities were analyzed. RESULTS: The duration of surgery was significantly shorter in the robotic group than in the laparoscopic group (5.17 h vs. 6.75 h, P<0.001), but there was no significant difference in overall survival and complication rates between the two groups. Among the urinary diversion modalities, the median survival was the longest in the intracorporeal ileal neobladder group (55 months), which was significantly better than that of the Bricker procedure (25 months) and ureterocutaneostomy (13 months) (P<0.001). Multifactorial analysis showed that elevated ASA classification (HR=14.99-20.16) and male gender (HR=1.96) were independent risk factors in the laparoscopic group, whereas prolonged operative duration was associated with a reduced risk (HR=0.56). In patients with the Bricker procedure, ASA classification (P=0.001) and gender (P=0.032) significantly influenced prognosis. CONCLUSION: Robot-assisted radical cystectomy (RARC) has significant short-term surgical advantages over laparoscopic radical cystectomy (LRC). Among different urinary diversion methods, intracorporeal ileal neobladder is associated with longer survival, although this largely reflects patient selection bias. The choice of specific surgical approach should be based on a comprehensive consideration of the patient's individual circumstances.