Preservation of endopelvic fascia, puboprostatic ligaments, dorsal venous complex and hydrodissection of the neurovascular bundles during robot-assisted radical prostatectomy: a video demonstration and propensity score matched outcomes

Introduction: We sought to report the oncologic and functional outcomes of endopelvic fascia (EPF), puboprostatic ligaments (PPL), and dorsal venous complex (DVC) preservation with hydrodissection of the neurovascular bundles (NVB) during robot-assisted radical prostatectomy (RARP). Materials and Methods: A retrospective review of our prospectively maintained prostate cancer database was performed. Patients who underwent bilateral or unilateral nerve sparing were identified. Propensity score matching was performed in a ratio of 1:1.6 between new technique (Group 1) and a historical group (Group 2). Data were reviewed for perioperative, oncologic, and functional outcomes. Cumulative incidence curves were used to depict perfect continence (0 pads), social continence (0-1 pads), and potency (SHIM≥17 with or without erectile aids). Multivariate models were used to elicit variables associated with continence and potency. Results: 76 patients in Group 1 and 126 patients in Group 2 were included. Median follow up was 17 months. Group 1 showed higher perfect continence rates at 1 month (9% vs 3%), 3 months (24% vs 19%), and 6 months (54% vs 34%) compared to Group 2 respectively (log rank p\u3c0.01). Group 1 also showed higher social continence rates at 1 month (15% vs 3%), 3 months (77% vs 32%), and 6 months (87% vs 53%) compared to Group 2 respectively (log rank p\u3c0.01). Group 1 had a similar potency rate compared to Group 2 (log rank p=0.25). Multivariate analysis showed that Group 1 was associated with improved perfect (Possibility ratio (PR) 1.82, 95% CI 1.29–2.58, p\u3c0.01) and social continence (PR 2.54, 95% CI 1.83 – 3.52, p\u3c0.01), but not potency. Conclusions: EPF, PPL, and DVC preservation with hydrodissection of the NVB offered similar oncological outcomes, but earlier and improved urinary continence rates compared to standard dissection

Relapses Rates and Patterns for Pathological T0 after Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium

OBJECTIVES: To investigate the oncologic outcomes of pT0 after robot-assisted radical cystectomy (RARC). METHODS: A retrospective review of the International Robotic Cystectomy Consortium database was performed. Patients with pT0 after RARC were identified and analyzed. Data were reviewed for demographics and pathologic outcomes. Kaplan Meier(KM) curves were used to depict recurrence free survival(RFS), disease specific survival(DSS), and overall survival(OS). Multivariate stepwise Cox regression models were used to identify variables associated with RFS and OS. RESULTS: 471 patients (18%) with pT0 were identified. Median age was 68 years (IQR 60-73), with a median follow up of 20 months (IQR 6-47). Thirty-seven percent received neoadjuvant chemotherapy (NAC) and 5% had pN+ disease. Seven percent of patients experienced disease relapse; 3% had local and 5% had distant recurrence. Most common sites of local and distant recurrences were pelvis (1%) and lungs (2%). Five-year RFS, DSS, and OS were 88%, 93% and 79%, respectively. Age (HR 1.05, 95% CI 1.01-1.09, p=0.02), pN+ve (HR 11.48, 95%CI 4.47 - 29.49, p\u3c0.01), and reoperations within 30 days (HR 5.53, 95% CI 2.08-14.64, p\u3c0.01) were associated with RFS. Chronic kidney disease (HR 3.24, 95% CI 1.45 - 7.23,p\u3c0.01), neoadjuvant chemotherapy (HR 0.41, 95%CI 0.18-0.92, p=0.03), pN+ve (HR 4.37, 95% CI 1.46-13.06, p\u3c0.01), and reoperations within 30 days (HR 2.64, 95% CI, 1.08 - 6.43, p=0.03) were associated with OS. CONCLUSIONS: Despite pT0 status at RARC, 5% had pN+ disease and 7% of patients relapsed. Node status was the strongest variable associated with RFS and OS in pT0

Analysis of Complications After Robot-Assisted Radical Cystectomy Between 2002-2021

OBJECTIVE: To identify trends in complications following robot-assisted radical cystectomy (RARC) using a multi-institutional database, the International Robotic Cystectomy Consortium (IRCC). METHODS: A retrospective review of the IRCC database was performed (2976 patients, 26 institutions from 11 countries). Postoperative complications were categorized as overall or high grade (≥ Clavien Dindo III) and were further categorized based on type/organ site. Descriptive statistics was used to summarize the data. Multivariate analysis (MVA) was used to identify variables associated with overall and high-grade complications. Cochran-Armitage trend test was used to describe the trend of complications over time. RESULTS: 1777 (60%) patients developed postoperative complications following RARC, 51% of complications occurred within 30 days of RARC, 19% between 30-90 days, and 30% after 90 days. 835 patients (28%) experienced high-grade complications. Infectious complications (25%) were the most prevalent, while bleeding (1%) was the least. The incidence of complications was stable between 2002-2021. Gastrointestinal and neurologic postoperative complications increased significantly (P \u3c .01, for both) between 2005 and 2020 while thromboembolic (P = .03) and wound complications (P \u3c .01) decreased. On MVA, BMI (OR 1.03, 95%CI 1.01-1.05, P \u3c .01), prior abdominal surgery (OR 1.26, 95%CI 1.03-1.56, P = .03), receipt of neobladder (OR 1.52, 95%CI 1.17-1.99, P \u3c .01), positive nodal disease (OR 1.33, 95%CI 1.05-1.70, P = .02), length of inpatient stay (OR 1.04, 95%CI 1.02-1.05, P \u3c .01) and ICU admission (OR 1.67, 95%CI 1.36-2.06, P \u3c .01) were associated with high-grade complications. CONCLUSION: Overall and high-grade complications after RARC remained stable between 2002-2021. GI and neurologic complications increased, while thromboembolic and wound complications decreased