Comparison of Stress Response during Robotic-Assisted Versus Open Radical Cystectomy in Bladder Cancer: A Prospective Observational Study - Abstract
Background: It not evaluated to what extent robot-assisted radical cystectomy (RARC) vs. open radical cystectomy (ORC) is associated with a stress response. This study evaluates the extent that RARC versus ORC is associated with a stress response, and hypothesized that plasma cortisol and catecholamine responses are smaller during RARC than during ORC. Methods: Plasma for determination of cortisol and catecholamines was obtained before surgery, after resection of the bladder, and at the end of surgery for 20 RARC and 20 ORC procedures. A prospective, one university/tertiary centre observational study. Results: Preoperative characteristics were not significantly different between RARC and ORC groups. During both RARC and ORC plasma cortisol was reduced with the lowest values after RARC (56 vs. 92 nmol/l, P=0.004). Plasma adrenaline also decreased, while plasma glucose increased during surgery without significant difference between groups. The duration of surgery and consequently the use of remifentanil was high in the RARC group (P=0.0001 and P=0.001) and the decrease in plasma cortisol was related to dose of remifentanil (r = -0.718, P=0.0001) besides to duration of surgery (r = -0.715, P=0.0001). Conclusion: Both plasma adrenaline and cortisol decreased during surgery and the decrease in plasma cortisol was pronounced during RARC related to the duration of the procedure. Thus under cover of propofol-remifentanil anesthesia cystectomy is not associated with a significant stress response.