Robotic Intracorporeal Orthotopic Ileal Neobladder: Replicating Open Surgical Principles

Lamb

et al. 2017

European Urology Focus

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.

Section: Discussionsupporting

confidence: 75%

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

Lamb

et al. 2017

European Urology Focus

“…Exceptions included prospective studies [8,22,28,35,36,43,52,59,64,66,81,87] and some multi-institutional retrospective collaboration studies [16,23,25,30,45,48,54,61,68]. Only two of the comparative studies were randomized [74,83] (LOE 2b); all other comparative studies were nonrandomized, whether prospective or retrospective (LOE 4).…”

Section: Evidence Synthesismentioning

confidence: 99%

Systematic Review and Cumulative Analysis of Oncologic and Functional Outcomes After Robot-assisted Radical Cystectomy

et al. 2015

Context: Although open radical cystectomy (ORC) is still the standard approach, laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) are increasingly performed.Objective: To report on a systematic literature review and cumulative analysis of pathologic, oncologic, and functional outcomes of RARC in comparison with ORC and LRC.Evidence acquisition: Medline, Scopus, and Web of Science databases were searched using a free-text protocol including the terms robot-assisted radical cystectomy or da Vinci radical cystectomy or robot* radical cystectomy. RARC case series and studies comparing RARC with either ORC or LRC were collected. A cumulative analysis was conducted.Evidence synthesis: The searches retrieved 105 papers, 87 of which reported on pathologic, oncologic, or functional outcomes. Most series were retrospective and had small case numbers, short follow-up, and potential patient selection bias. The lymph node yield during lymph node dissection was 19 (range: 3-55), with half of the series following an extended template (yield range: 11-55). The lymph node-positive rate was 22%. The performance of lymphadenectomy was correlated with surgeon and institutional volume. Cumulative analyses showed no significant difference in lymph node yield between RARC and ORC. Positive surgical margin (PSM) rates were 5.6% (1-1.5% in pT2 disease and 0-31% in pT3 and higher disease). PSM rates did not appear to decrease with sequential case numbers. Cumulative analyses showed no significant difference in rates of surgical margins between RARC and ORC or RARC and LRC.Neoadjuvant chemotherapy use ranged from 0% to 31%, with adjuvant chemotherapy used in 4-22% of patients. Only six series reported a mean follow-up of >36 mo. Three-year disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) rates were 53-74%, 68-83%, and 72-80%, respectively. The 5-yr DFS, CSS, and OS rates were 53-74%, 66-80%, and 39-66%, respectively. Similar to ORC, disease of higher pathologic stage or evidence of lymph node involvement was associated with worse survival. Very limited data were available with respect to functional outcomes. The 12-mo continence rates with continent diversion were 83-100% in men for daytime continence and 66-76% for nighttime continence. In one series, potency was recovered in 63% of patients who were evaluable at 12 mo. Conclusions

“…Most of the surgical series were retrospective, single-center studies, with the exception of some prospective studies [8,9,29,32,33,48,62,63,67,69,71,73,77] and some multi-institutional collaboration papers [19,24,26,30,38,39,43,45,72] (LOE 4). Only three of the comparative studies were randomized [78][79][80] (LOE 2b); all other comparative studies were nonrandomized, whether prospective or retrospective (LOE 4).…”

Section: Quality Of the Studies And Level Of Evidencementioning

confidence: 99%

Systematic Review and Cumulative Analysis of Perioperative Outcomes and Complications After Robot-assisted Radical Cystectomy

et al. 2015

Context: Although open radical cystectomy (ORC) is still the standard approach, laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) have gained popularity.Objective: To report a systematic literature review and cumulative analysis of perioperative outcomes and complications of RARC in comparison with ORC and LRC.Evidence acquisition: Medline, Scopus, and Web of Science databases were searched using a free-text protocol including the terms robot-assisted radical cystectomy or da Vinci radical cystectomy or robot* radical cystectomy. RARC case series and studies comparing RARC with either ORC or LRC were collected. Cumulative analysis was conducted.