Robot‐assisted partial cystectomy: perioperative outcomes and early oncological efficacy

Abstract

ObjectiveTo report on patients undergoing robot-assisted partial cystectomy (RAPC), focusing on perioperative outcomes over a range of clinical, anatomical and pathological variables, as well as the overall oncological efficacy of this approach. Patients and MethodsWe retrospectively reviewed all patients who underwent RAPC by a single surgeon between 2005 and 2015. We identified 29 patients who underwent surgery for definitive management of a primary bladder tumour. Clinicopathological data and perioperative variables were recorded. Continuous variables were compared using the Student's t-test. Prediction of perioperative outcomes for those undergoing RAPC for intra-diverticular neoplasms was done using univariate logistic regression. Survival was estimated using the Kaplan-Meier method. ResultsThe median (interquartile range) patient age was 75 (65-81) years, 18 patients (62.1%) had an American Society of Anesthesiologists classification of ≥3, and 10 patients (34.5%) had a history of prior abdominal surgery. The median estimated blood loss (EBL) was 50 mL and the median length of stay (LOS) was 1 day. Two patients (6.9%) had a perioperative complication and five (17.9%) a post-discharge complication at ≤90 days, all of which were minor. The positive surgical margin rate was 3.6% and in those with muscle-invasive disease a median of 12 lymph nodes were removed. Neither the size of diverticulum nor the need for ureteric re-implantation was predictive of LOS, EBL, or complication (P > 0.05). We did not encounter any wound, port site, or unusual recurrence patterns to suggest the technical factors of a robotic approach influenced oncological outcomes. The 5-year overall and recurrence-free survival rates were 79% and 68%, respectively. ConclusionRAPC confers the ability to achieve favourable outcomes with low morbidity and reduced hospital stays. Oncological efficacy compares favourably with the published literature. For experienced surgeons, this may represent the optimal surgical approach for organ-preserving bladder surgery.

Partial cystectomy for muscle-invasive bladder cancer: a review of the literature

“…Specifically, one patient required re-exploration, and another required percutaneous drainage of lymphocele. Golombos et al reported two perioperative complications (6.9%) and 5 (17.9%) complications within 90 days of surgery, all of which were minor (31). Nevertheless, a comparison of reported complications after RC reveals that the morbidity associated with a PC is notably less.…”

Bladder diverticulectomy using a pre-peritoneal, trans-vesicle approach with the SP platform: A novel approach

“…The authors site a historical concern for recurrence following partial cystectomy, ranging between 38% and 78% in pilot studies. 5 Our approach minimizes this risk by internally isolating the tumor within the diverticulum in order to avoid tumor spillage.…”

Robotic Partial Cystectomy for Urachal Carcinoma: A Case Report and Review of the Literature

“…This demonstrates a possible role for LND in accurate staging which might change treatment decisions depending on positivity. In the 2016 meta-analysis by Szarvas et al, only 17% of patients that underwent LND were found to be positive [ 11 ]. Such patients were allocated to LND given high-risk features and still yielded relatively low rates of positivity.…”

“…Given that the risk of “seeding” in adenocarcinoma remains significantly less than that of urothelial carcinoma of the bladder. In their retrospective study, Golombos et al showed that adhering to traditional indications of ruling out CIS before partial cystectomy and having a tumor in a favorable location, this technique demonstrates both favorable recurrence and survival rates [ 11 ]. In our case, care was taken to remove the specimen en bloc with the umbilicus after suspending the whole specimen ( Figure 3 ); resection was also done on an empty bladder with a foley catheter in place as to avoid urine spillage as much as possible.…”