In-depth Critical Analysis of Complications Following Robot-assisted Radical Cystectomy with Intracorporeal Urinary Diversion

Abstract

In-depth critical analysis of complications following robot-assisted radical cystectomy with intracorporeal urinary diversion. European Urology Focus, (doi:10.1016Focus, (doi:10. /j.euf.2016 This is the author's final accepted version.There may be differences between this version and the published version. You are advised to consult the publisher's version if you wish to cite from it.http://eprints.gla.ac.uk/145598/ RESULTS AND LIMITATIONSThe 90-day all complication rate following ileal conduit and continent diversion was 68% and 82.4% while major complications were 21.0% and 20.6% respectively. 90-day mortality was 3% and 2.9% for ileal conduit and continent diversion patients respectively. On multivariate analysis, blood transfusion requirement was independently associated with major (p=0.002) and all 30-day (p=0.002) and 90-day major complications (p=0.012) while male patients were associated with 90-day major complications (p=0.015). Critical analysis identified surgical complications was responsible for 39.4% of all 90-day major complications. PATIENT SUMMARYIn this report, we looked at the surgical outcomes in bladder cancer patients treated with minimal invasive robotic surgery. We found that surgical complications account for most major complications and previous surgical experience may be a confounding factor when interpreting results from different center even in a randomised trial setting.

Robotic Assisted Radical Cystectomy with Extracorporeal Urinary Diversion Does Not Show a Benefit over Open Radical Cystectomy: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

“…A recent study analysed complications following RARC with intracorporeal urinary diversion in 134 cases and found that the majority of Clavien ≥III complications can be attributed to a surgical cause which may be related to surgeon experience [23]. In our meta-analysis of operating time, there was significant heterogeneity observed which may reflect a variation in surgical experience in RARC.…”

Examining the relationship between complications and perioperative mortality following radical cystectomy: a population‐based analysis

“…). Based on our present findings, we would hypothesise that the early management of postoperative complications may avoid a situation where ‘complications beget complications’ leading not only to a more challenging recovery and increased healthcare costs, but ultimately to increased rate of mortality as well .…”

Intracorporeal robot‐assisted radical cystectomy, together with an enhanced recovery programme, improves postoperative outcomes by aggregating marginal gains

“…Historic reports of ORC performed at high‐volume institutions reported a 58–64% 90‐day complication rate after surgery, with a 13–22% major complication rate . Previously, we reported a 90‐day all and major complication rate of 72% and 21%, respectively, with a median hospital LOS of 10.5 days in 134 consecutive iRARC cases . According to UK and USA population data, the mean LOS after cystectomy before the advent of ERAS was 19 and 11 days, respectively .…”