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

• Published in: BJU international 2020-10, Vol.126 (4), p.464-471
• Main Authors: Hosseini, Abolfazl, Mortezavi, Ashkan, Sjöberg, Siri, Laurin, Oscar, Adding, Christofer, Collins, Justin, Wiklund, Peter N.
• Format: Article
• Language: English
• Subjects: Aged; Bladder cancer; bladder neoplasm; Cohort Studies; complications; cystectomy; Cystectomy - adverse effects; Demography; Female; Humans; ileal neobladder; intracorporeal; Laparoscopy; Lymph nodes; Male; Medicin och hälsovetenskap; Middle Aged; Morbidity; Mortality; Operative Time; Patients; Postoperative Complications - epidemiology; Robotic surgery; robotic surgical procedures; Robotic Surgical Procedures - adverse effects; Surgery; Survival; Treatment Outcome; Urinary Bladder Neoplasms - mortality; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - surgery; urinary diversion; Urinary Diversion - adverse effects
• ISSN: 1464-4096; 1464-410X; 1464-410X
• DOI: 10.1111/bju.15112

Objective 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 ±98) min, with a median (range) estimated blood loss of 300 (50–2200) mL. Most of the men (86%) received a nerve‐sparing 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.