Comparação entre as implicações anestésicas e defechos das cistectomias radicais abertas e robóticas: Estudo Retrospectivo de 5 anos em Hospital Universitário

Abstract

Radical cystectomy remains the standard treatment for invasive bladder cancer; however, itinvolves significant anesthetic risks, particularly in elderly patients and those with comorbidities. With the advancement of robotic surgery, new anesthetic challenges have emerged,such astheneed for extreme patient positioning and prolonged pneumoperitoneum. This retrospective, cross- sectional, and observational study compared anesthetic complications between open and robotic radical cystectomies performed at a university hospital over five years. A total of 44 patients were included, with 29 undergoing open cystectomy and 15 undergoing robotic cystectomy. Data were extracted from electronic medical records, including demographic variables, physical status according to the ASA classification, intraoperative hemodynamic parameters, need for vasopressor drugs, ventilatorycomplications, postoperativeopioid consumption, ICU length of stay, timeto oral diet reintroduction, total hospital stay, and occurrence of anesthetic complications. Statistical analysis included the Shapiro-Wilk test to assess the normalityof variables, followedbyStudent's t- test or the Mann-Whitney test for continuous variables, and the chi-square or Fisher's exact test for categorical variables. Ridge logistic regression was applied to identify predictors of anesthetic complications. The results showed no statistically significant difference in the incidence of intraoperative hypotension (p = 0.492), need for vasopressor drugs (p = 0.512), or ventilatory complications (p > 0.05). The robotic surgery group had lower intraoperative bleeding (p = 0.002), but without a statistically significant reduction in transfusion requirements (p = 0.11). Opioid consumption was significantly higher in the open surgery group (p = 0.004), suggesting a greater postoperative pain impact in this group. No significant differences were observed in mortality rates (p = 1.00), late anesthetic complications, or total hospital length of stay (p = 0.980). In conclusion, robotic cystectomy presents advantages such as reduced blood loss and lower opioid requirements, without compromising hemodynamic stabilityor increasing anesthetic complications. However, the choice of surgical technique should be based on individual patient factors, as hospital length of stay and overall recovery did not differ between groups