Predicting perioperative outcomes of robot‐assisted radical cystectomy: Data from the Asian Robot‐Assisted Radical Cystectomy Consortium

Lee, Alvin Yuanming; Allen, John C.; Teoh, Jeremy Yuen‐Chun; Kang, Seok‐Ho; Patel, Manish I.; Muto, Satoru; Yang, Chih-Hui; Zhang, Ruiyun; Kijvikai, Kittinut; Chen, Haige; Οhyama, Chikara; Horie, Shigeo; Chan, Eddie Shu‐Yin; Lee, Lui Shiong

doi:10.1111/iju.14937

Cited by 2 publications

(3 citation statements)

References 29 publications

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“…In their study, the overall complication rate was 69%, and that of high-grade complications was 25% within 90 days in the current cohort ( 15 ), which was relatively similar to the rate observed in our cohort. Recently, a review of the Asian Robot-Assisted Radical Cystectomy Consortium database was published ( 16 ). The overall complication rate was 49.2%, whereas high-grade complications were 15.6% ( 16 ).…”

Section: Discussionmentioning

confidence: 99%

“…Recently, a review of the Asian Robot-Assisted Radical Cystectomy Consortium database was published ( 16 ). The overall complication rate was 49.2%, whereas high-grade complications were 15.6% ( 16 ). The rate was relatively excellent, which might be because the Consortium is organized by nine academic institutions located in Asia and Australia, including two high-volume centers in Japan.…”

Section: Discussionmentioning

confidence: 99%

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Postoperative complications and determinant of selecting non intracorporeal urinary diversion in patients undergoing robot-assisted radical cystectomy: an initial experience

Inoue,

Kato,

Sasaki

et al. 2024

Transl Cancer Res

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Background Robot-assisted radical cystectomy (RARC) with urinary diversion has become a standard surgical procedure because of its three-dimensional high-definition surgical field of view, flexibility, and stability. However, because of the highly complex steps of surgery, postoperative complications cannot be ignored. Methods This retrospective, single-center, observational cohort study investigated the postoperative complications following RARC at a non-high-volume center in Japan. From August 2019 to March 2023, 50 consecutive patients who underwent RARC for histologically proven muscle-invasive bladder cancer (MIBC) or high-risk non-MIBC with an indication for radical cystectomy according to the Japanese Urological Association Guideline 2019 were included. Factors correlated with the selection of extracorporeal urinary diversion (ECUD) or cutaneous ureterostomy rather than intracorporeal urinary diversion (ICUD) for urinary diversion were also investigated. Results In total, 33 (66%) and 31 (62%) patients experienced complications during the first 90 and 30 days after RARC, respectively. Among them, 19 (38%) and 18 (36%) patients developed Clavien-Dindo classification G2 complications, and 12 (24%) and 11 (22%) developed G3 or higher (major) complications during the first 90 and 30 days after RARC, respectively. The most common complications were gastrointestinal complications (26%) and urinary tract infections (22%). Nine patients (18%) underwent surgical intervention within 90 days of undergoing RARC. Higher infusion volume during the operations was significantly correlated with the occurrence of major complications within 90 days (P=0.025) and 30 days (P=0.0158) after RARC. Nineteen patients (38%) underwent non-ICUD. Twelve patients received ECUD as an ileal conduit or neobladder, and among them, three patients received ECUD due to intraabdominal adhesion for previous abdominal surgery or radiation, while four patients received ECUD ileal conduit due to comorbidities and advanced cases (palliative surgery) to shorten the surgery time. Conclusions Surgical complications related to the initial experience with RARC at a non-high-volume center in Japan cannot be ignored. Although this complicated surgical procedure requires a learning curve to achieve a stable rate of much fewer major complications after RARC, careful assessment of patients’ status before surgery and critical postoperative management may reduce complication rates more quickly, even at non-high-volume centers.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Postoperative complications and determinant of selecting non intracorporeal urinary diversion in patients undergoing robot-assisted radical cystectomy: an initial experience

Inoue,

Kato,

Sasaki

et al. 2024

Transl Cancer Res

View full text Add to dashboard Cite

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“…Minimally invasive surgeries significantly decrease the incidence of SSIs in various surgeries; hence, RARC is also expected to decrease the incidence of SSI compared to ORC 11 . However, several previous studies evaluating the perioperative outcomes of RARC did not distinguish between the incidence of SSIs and urinary tract infections when assessing the prevalence of infectious complications or evaluating the prevalence of SSIs according to the criteria defined in the Centers for Disease Control and Prevention (CDC) guidelines 12–14 . Furthermore, no studies have evaluated in detail the differences in SSI characteristics between RARC and ORC or the etiology related to the differences in incidence.…”

Section: Introductionmentioning

confidence: 99%

Lower bleeding volume contributes to decreasing surgical site infection in radical cystectomy: A propensity score‐matched comparison of open versus robot‐assisted radical cystectomy

Kamei,

Endo,

Yamazaki

et al. 2024

Int J of Urology

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ObjectivesTo compare the incidence of surgical site infections (SSI) between robot‐assisted and open radical cystectomies and investigate the risk factors for SSI after radical cystectomies.MethodsConsecutive patients who underwent radical cystectomy between July 2008 and December 2022 were retrospectively reviewed. The prevalence and characteristics of SSI after open and robot‐assisted radical cystectomies were compared, and the risk factors for SSI were investigated using propensity score matching.ResultsThis study enrolled 231 patients (open: 145, robot‐assisted: 86). In the robot‐assisted group, urinary diversion was performed using an intracorporeal approach. SSI occurred in 34 (open: 28, robot‐assisted: 6) patients, and the incidence was significantly lower in the robot‐assisted group (19.3% vs. 7.0%, p = 0.007). After propensity score matching cohort (open: 34, robot‐assisted: 34), increased bleeding volume, blood transfusion, and delayed postoperative oral feeding were significantly associated with SSI. Only increased bleeding volume remained a significant risk factor in the multivariate regression analysis (odds ratio, 1.13 [per 100 mL increase]; 95% confidence interval: 1.02–1.25; p = 0.001). The cutoff bleeding volume for predicting SSI was 1630 mL with an area under the receiver operating characteristic curve, sensitivity, and specificity of 0.773, 0.73, and 0.75, respectively.ConclusionsThe incidence of SSI after robot‐assisted radical cystectomy was significantly lower than that after the open procedure. However, decreased bleeding volume, which was significantly associated with robot‐assisted procedures, was an independent and more significant factor for reducing SSI after radical cystectomy than the differences of the surgical procedure even after propensity score matching.

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Predicting perioperative outcomes of robot‐assisted radical cystectomy: Data from the Asian Robot‐Assisted Radical Cystectomy Consortium

Cited by 2 publications

References 29 publications

Postoperative complications and determinant of selecting non intracorporeal urinary diversion in patients undergoing robot-assisted radical cystectomy: an initial experience

Postoperative complications and determinant of selecting non intracorporeal urinary diversion in patients undergoing robot-assisted radical cystectomy: an initial experience

Lower bleeding volume contributes to decreasing surgical site infection in radical cystectomy: A propensity score‐matched comparison of open versus robot‐assisted radical cystectomy

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