Decaestecker, Karel

Hosseini, Abolfazl

Poelaert, Filip

Vanmarsnille, Tim

Ghent University Academic Bibliography

Robot-assisted versus open radical cystectomy:complication rates and perioperative results in a single academic centerDecaestecker Karel1, Vanmarsnille Tim1, Poelaert Filip1, Hosseini Abolfazl21 Urology, Ghent University Hospital, Ghent, Belgium ;  ² Urology, Karolinska University Hospital, Stockholm, SwedenIntroduction and objectivesThe gold standard treatment for muscle invasive bladder cancer is open radical cystectomy (ORC) with pelvic lymph node dissection and urinary diversion. Robot-assisted radical cystectomy (RARC) is still considered not a standard of care because of concerns aboutperioperative patient safety and long-term functional and oncological outcomes and the added direct cost of robotic surgery.We assessed the perioperative results and complication rates of both procedures in a single academic center.MethodsClinical data of the first 67 patients undergoing RARC between May 2013 and Total (n=117) Open (n=50) RARC (n=67) p-valuePatient and tumor characteristicsMale [n (%)] 95 (81.2) 40 (80.0) 55 (82.1) 0.775Age [mean (95%CI)] 69 (67 – 71) 71 (68 – 74) 68 (65 – 70) 0.068October 2015 were prospectively documented (EC 2013/874) and retrospectively compared with the last 50 patients undergoing ORC between November 2010 and May 2013 in a single academic center.ORC was performed by a senior surgeon or a supervised junior surgeon (KD), BMI [median (range)] 26 (17 – 38) 25 (18 – 38) 26 (17 – 36) 0.232ASA [n (%)] I 1 (0.8) 1 (2.0) 0 (0.0) 0.045II 53 (45.3) 17 (34.0) 36 (53.7)III 58 (49.6) 28 (56.0) 30 (44.8)IV 5 (4.3) 4 (8.0) 1 (1.5)Neoadj. chemo [n (%)] 19 (16.6) 3 (6.0) 16 (23.9) 0.009preop BCG [n (%)] 32 (27.4) 14 (28.0) 18 (26.9) 0.892whereas RARC was done by a single surgeon (KD) after training by an experienced RARC surgeon (AH). Urinary diversion was predominantly performed intracorporeal(88%). Complications were graded on day 30 and 90 using the Clavien Dindoclassification. SPSS v23 was used for statistical analysis.pT stage [n (%)] pT0 6 (5.2) 2 (4.2) 4 (6.0) 0.530≤ pT1 40 (34.8) 16 (33.3) 24 (35.8)pT2 14 (12.2) 4 (8.3) 10 (14.9)pT3 34 (29.6) 14 (29.2) 20 (29.9)pT4 2 (18.3) 12 (25.0) 9 (13.4)Prostate Ca [n (%)] 31 (32.6) 13 (32.5) 18 (32.7) 0.981Operative parametersResultsBoth groups are fairly comparable regarding patient and tumor characteristics.PLND [n (%)] 102 (87.2) 37 (74.0) 65 (97.0) <0.001pN+ [n (%)] 39 (33.3) 15 (30.0) 24 (35.8) 0.509N yield [median (range)] 14 (0 – 37) 4 (0 – 37) 17 (0 – 32) <0.001Positive margin bladder [n (%)] 14 (12.5) 12 (26.1) 2 (3.0) <0.0015 missing 4 missing 1 missingDiversion method[n (%)]ileal conduit 63 (53.8) 26 (52.0) 37 (55.2) <0.001neobladder 38 (32.5) 9 (18.0) 29 (43.3)However, patients in the ORC group had a slightly higher ASA score and patientsin the RARC group received significantly more neo-adjuvant chemotherapy.RARC patients had a significant longer operation time, but they received significantlycutaneostomy 16 (13.7) 15 (30) 1 (1.5)Bloodloss [ml, median (range)] 250 (5 – 1200) 300 (50 – 1200) 250 (5 – 1000) 0.04228 missing 28 missingTransfusion [n (%)] 30 (25.6) 28 (56.0) 2 (3.0) <0.001Operation time [min, median (range)]390 (115 – 720) 355 (115 – 655) 420 (240 – 720) <0.001LoS [days, median (range)] 13 (3 – 75) 18 (3 – 75) 11 (5 – 36) <0.001more PLND, more neobladder reconstruction and had less blood loss and a much lower transfusion rate.Total (n=117)Open (n=50) RARC (n=67) p-valueComplications In the RARC group, 16.4% of patients encountered a high-grade complicationClavien Dindo 0 – 30 days [n (%)]0 39 (33.3) 19 (38.0) 20 (29.9) 0.005I – II 56 (47.9) 16 (32.0) 40 (59.7)III – IV 19 (16.2) 12 (24.0) 7 (10.4)V 3 (2.6) 3 (6.0) -Clavien Dindo 30 – 90 days [n (%)]0 81 (73.0) 42 (84.0) 39 (63.9) <0.001I – II 19 (17.1) 1 (2.0) 18 (29.5)III – IV(CD III-V) in the first 90 days versus 40.0% of patients in the ORC group(p=0.001). More low-grade complications (CD I-II) were registered in the RARC group, which could be due to the nature of the study design (prospective versus retrospective). RARC patients had a significantly shorter11 (9.9) 7 (14.0) 4 (6.6)V - - -Clavien Dindo 0 – 90 days [n (%)]0 26 (23.4) 15 (30.0) 11 (18.0) 0.001I – II 55 (49.5) 15 (30.0) 40 (65.6)III – IV 27 (24.3) 17 (34.0) 10 (16.4)V 3 (2.7) 3 (6.0) -Readmissions < 90 days [n (%)] 14 (12.7) 9 (18.0) 5 (8.3) 0.130length of stay (LoS) in the hospital (11 versus 18 days) and a comparablereadmission rate.ConclusionRARC with intracorporeal urinary diversion was safely introduced despite the learning curve and without compromise in oncologicalcorrect surgery or possible neobladder reconstruction. RARC can provide significant advantages over ORC regarding bloodloss, transfusion rate, high-grade complications and hospital stay.Accurate and standardized reporting of complications is necessary to guide patient counseling.

Robot-assisted versus open radical cystectomy : complication rates and perioperative results in a single academic center

https://biblio.ugent.be/publication/8549366/file/8549367

Robot-assisted versus open radical cystectomy : complication rates and perioperative results in a single academic center

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