Robot-Assisted Radical Cystectomy for Bladder Cancer. Single-Center Experience
Valentin Pavlov, Marat Urmantsev*, Ruslan Safiullin, Anton Denejko, Rita Gilmanova and Ruslan Abdrakhimov
Bashkir State Medical University, Russia, Ufa
*Corresponding Author: Marat Urmantsev, Bashkir State Medical University, Russia, Ufa.
Received:
July 29, 2021; Published: January 31, 2022
Abstract
Objective: Radical cystectomy remains the most effective treatment for patients with localized, invasive bladder cancer and recurrent noninvasive disease. Recently some surgeons have begun to describe outcomes associated with less invasive surgical approaches to this disease, such as laparoscopic or robotic assisted techniques. We report our maturing experience with 100 consecutive cases of robotic assisted laparoscopic radical cystectomy regarding perioperative results, pathological outcomes, and surgical complications.
Materials and Methods: A total of 100 consecutive patients (73 male and 27 female) underwent robotic radical cystectomy with intracorporeal urinary diversion at our institution from February 2018 to February 2021 for clinically localized bladder cancer. Outcome measures evaluated included operative variables, hospital recovery, pathological outcomes, and complication rate.
Results: The mean age of this cohort was 60.4 years (range 38 to 82). Ninety-five patients underwent ileal conduit diversion, 5 received a neobladder). The mean operating room time for all patients was 184 min and mean surgical blood loss was 286 ml. On surgical pathology, 2% of the cases were pT1, 35% were pT2, 51+12% were pT3/T4 disease and 17% were node positive. The mean number of lymph nodes removed was 16 (range 10 to 40). In no case was there a positive surgical margin. The mean days to flatus were 2.6, bowel movement 2.8 and discharge home 8.2. There were 21 postoperative complications in 20 patients with 4% having a major complication (Clavien grade 3 or higher) and 15% being readmitted within 30 days after surgery. At a mean follow-up of 12 months 3 patients had disease recurrence and died 4 of disease.
Conclusions: We report a relatively large cohort and maturing experience with robotic radical cystectomy for the treatment of bladder cancer, providing acceptable surgical and pathological outcomes. These results support continued efforts to refine the surgical management of muscle-invasive bladder cancer.
Keywords: Radical Cystectomy; Bladder Cancer; Robot-Assisted; Umbilical
References
- International Agency for Research on Cancer. Global Cancer Observatory.
- Shabsigh A., et al. “Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology”. European Urology 1 (2009): 164-174.
- Lowrance WT., et al. “Contemporary open radical cystectomy: analysis of perioperative outcomes”. The Journal of Urology 179 (2008): 1313-1318.
- Ukimura O., et al. “Laparoscopic radical cystectomy and urinary diversion”. Current Urology Reports 6 (2005): 118-121.
- Bochner BH., et al. Memorial Sloan Kettering Cancer Center Bladder Cancer Surgical Trials Group. “A randomized trial of robot-assisted laparoscopic radical cystectomy”. The New England Journal of Medicine 4 (2014): 389-390.
- Khan MS., et al. “A Single-centre Early Phase Randomised Controlled Three-arm Trial of Open, Robotic, and Laparoscopic Radical Cystectomy (CORAL)”. European Urology4 (2016): 613-621.
- Novara G., et al. “Systematic review and cumulative analysis of perioperative outcomes and complications after robot-assisted radical cystectomy”. European Urology3 (2015): 376-401.
- Guliev BG and Bolokotov RR. “Robot-assisted and open radical cystectomy: comparative analysis of results”. Urology Herald1 (2020): 59-68.
- Challacombe BJ., et al. “The role of laparoscopic and robotic cystectomy in the management of muscle-invasive bladder cancer with special emphasis on cancer control and complications”. European Urology 60 (2011): 767-775.
- Gill I and Cacciamani G. “The changing face of urologic oncologic surgery from 2000-2018 (63141 patients) - impact of robotics”. European Urology 199 (2019): e656-e657.
- Mistretta FA., et al. “Minimally invasive versus open radical cystectomy: long term oncologic outcomes compared”. Translational Andrology and Urology 3 (2020): 1006-1008.
- Feng D., et al. “Comparative effectiveness of open, laparoscopic and robot-assisted radical cystectomy for bladder cancer: a systematic review and network meta-analysis”. Minerva Urology and Nephrology3 (2020): 251-264.
- Fonseka T., et al. “Comparing robotic, laparoscopic and open cystectomy: a systematic review and meta-analysis”. Archives of Italian Urology and Andrology 1 (2015): 41-48.
- Khan MS., et al. “Long-term Oncological Outcomes from an Early Phase Randomised Controlled Three-arm Trial of Open, Robotic, and Laparoscopic Radical Cystectomy (CORAL)”. European Urology1 (2020): 110-118.
- Kim TH., et al. “Oncological outcomes in patients treated with radical cystectomy for bladder cancer: comparison between open, laparoscopic, and robot-assisted approaches”. Journal of Endourology7 (2016): 783-791.
- Hussein AA., et al. “Outcomes of intracorporeal urinary diversion after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium”. The Journal of Urology 199 (2018): 1302-1311.
- Porreca A., et al. “Robot-assisted radical cystectomy with totally intracorporeal urinary diversion: surgical and early functional outcomes through the learning curve in a single high-volume center”. Journal of Robotic Surgery (2019): 1-9.
- Khan MS., et al. “A single-centre early phase randomised controlled three-arm trial of open, robotic, and laparoscopic radical cystectomy (CORAL)”. European Urology 69 (2016): 613-621.
- Porreca A., et al. “Robot assisted radical cystectomy with totally intracorporeal urinary diversion: initial, single-surgeon’s experience after a modified modular training”. Minerva Urology and Nephrology 70 (2018): 193-201.
- Richards KA., et al. “Does initial learning curve compromise outcomes for robot-assisted radical cystectomy? A critical evaluation of the first 60 cases while establishing a robotics program”. Journal of Endourology 25 (2011): 1553-1558.
- Sim A., et al. “Robot-assisted radical cystectomy and intracorporeal urinary diversion-safe and reproducible?” Central European Journal of Urology 68 (2015): 18.
- Kader AK., et al. “Robot-assisted laparoscopic vs opens radical cystectomy: comparison of complications and perioperative oncological outcomes in 200 patients”. BJU International 112 (2013): e290-e294.
- Canda AE., et al. “Robot-assisted nerve-sparing radical cystectomy with bilateral extended pelvic lymph node dissection (PLND) and intracorporeal urinary diversion for bladder cancer: initial experience in 27 cases”. BJU International 110 (2012): 434-444.
- Schumacher MC., et al. “Surgery-related complications of robot-assisted radical cystectomy with intracorporeal urinary diversion”. Urology 77 (2011): 871-876.
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