Robot‐assisted intracorporeal orthotopic bladder substitution after radical cystectomy: perioperative morbidity and oncological outcomes – a single‐institution experience

Abstract

To report a single-institution experience with totally intracorporeal neobladder urinary diversion (UD) after robot-assisted laparoscopic radical cystectomy (RARC). Patients and methods A total of 158 patients underwent totally intracorporeal neobladder UD after RARC between 2003 and 2016. Patient demographics, intraoperative and pathological data, 30-and 90-day perioperative mortality and complications were recorded. Complications were classified according to the modified Clavien-Dindo classification. The 5-year overall (OS) and cancer-specific survival (CSS) rates were estimated by Kaplan-Meier plots. Results Most of the patients were male (84%) and had clinical T Stage ≤2 (87%). The mean operation time was 359 (SD AE98) min, with a median (range) estimated blood loss of 300 (50-2200) mL. Most of the men (86%) received a nervesparing procedure and 38% of the females an organ-sparing approach. A lymph node dissection was performed in 156 (99%) patients, with a median (range) yield of 23 (7-48) nodes. Conversion to open surgery occurred in five patients (3%). We recorded negative margins in 156 patients (99%). The median (range) follow-up was 34 (1-170) months, with 30-and 90-day mortality rates of 0%. Clavien-Dindo Grade III-IV complications occurred in 29 of 158 (18%) patients at 30-days and in eight of 158 (5%) between 30-90 days, resulting into a 90-day overall high-grade complication rate of 23%. The unadjusted estimated 5-years recurrence-free survival, CSS and OS rates were 70%, 72%, and 71%, respectively. Conclusion In our present series the complication and oncological results were similar to open RC series, suggesting that RARC followed by totally intracorporeal neobladder UD is a safe and feasible alternative.

Impact of Clinical Response to Neoadjuvant Chemotherapy in the Era of Robot Assisted Radical Cystectomy: Results of a Single-Center Experience

“…The rate of major perioperative complications after RARC (Clavien III–V) was comparable between groups ranging between 7–14.3% ( p = 0.634). This is in line with recent multicentric studies, describing a negligible impact of NACT on the perioperative surgical morbidity of RARC [ 23 ]. The low incidence of overall complications reported may be reflective of both yearly high RARC caseload of the center and the experience of the surgical team gained over years [ 24 ].…”

Role of the Laparoscopic Approach for Complex Urologic Surgery in the Era of Robotics

“…LRC with ICUD is a complex procedure [ 41 ]. Due to the limitations of laparoscopy in regard to reconstructive interventions, there is little experience in the field of ICUD, with few cases published in the literature [ 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ] ( Table 4 ).…”

The impact of orthotopic neobladder vs ileal conduit urinary diversion after cystectomy on the survival outcomes in patients with bladder cancer: A propensity score matched analysis

“…3 Intracorporeal ON is a difficult technique, and thus, is associated with a higher rate of high-grade complications. 8,9 Complications due to urinary diversion can prolong the hospital stay, increase hospitalization expenses, and impact all-other cause survival. Different kinds of complications related to urinary diversion after RC have been reported, but most are due to the use of the bowel for urinary diversion.…”

“…The reason for this phenomenon may be due to increased adoption of robotic radical cystectomy and increased utilization of intracorporeal urinary diversion 3 . Intracorporeal ON is a difficult technique, and thus, is associated with a higher rate of high‐grade complications 8,9 . Complications due to urinary diversion can prolong the hospital stay, increase hospitalization expenses, and impact all‐other cause survival.…”