1761 COMPARISON OF 90-DAY PERI-OPERATIVE OUTCOMES BETWEEN ROBOT-ASSISTED AND OPEN RADICAL CYSTECTOMY IN 203 CONSECUTIVE PATIENTS

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive III1 Apr 20121761 COMPARISON OF 90-DAY PERI-OPERATIVE OUTCOMES BETWEEN ROBOT-ASSISTED AND OPEN RADICAL CYSTECTOMY IN 203 CONSECUTIVE PATIENTS Kyle Richards, A. Karim Kader, L. Spencer Krane, and Ashok Hemal Kyle RichardsKyle Richards Winston-Salem, NC More articles by this author , A. Karim KaderA. Karim Kader San Diego, CA More articles by this author , L. Spencer KraneL. Spencer Krane Winston-Salem, NC More articles by this author , and Ashok HemalAshok Hemal Winston-Salem, NC More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.1777AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Open radical cystectomy (ORC) is the gold standard treatment for the management of select patients with bladder cancer. Despite it's proven mortality benefit it is associated with substantial peri-operative morbidity, which, despite advances in surgical and anesthetic technique, have remained relatively constant over the last decade. We sought to determine the impact of the robotic approach on 90 day peri-operative and short-term oncologic outcomes. METHODS A robot assisted radical cystectomy (RARC) program was established at our institution in January 2008. Data was compiled prospectively in an institutional review board approved database. The Clavien system was used to report complications. A total of 124 patients have undergone RARC for bladder cancer from 2008-2011 and those with 90 day follow-up were included in this analysis. Data was retrospectively compiled on 100 consecutive patients that underwent ORC at our institution from 2005-2011. Uni- & multivariate nominal logistic regression analysis was used to identify predictors of complications. RESULTS A total of 100 ORC patients and 103 RARC patients had 90 days of follow-up and were included in this analysis. These patients did not differ in sex, age, BMI, previous abdominal surgery, radiation or systemic chemotherapy. More patients in the RARC group had an ileal conduit 97% vs 83% (p=0.03) and these procedures took longer, 451 min vs 393 min (P<0.0001). The RARC was associated with less blood loss, 423 cc vs 986 cc (P<0.0001), less need for blood transfusion, 15% vs 47% (P<0.0001) and decreased median length of stay, 6 vs 8 days (P<0.0001), when compared to ORC. RARC patients had less overall 35% vs 57% (P=0.0013) and major (Clavien ≥ 3), 10% vs 22% (p=0.0187) complications than ORC patients. In multivariate regression analyses, RARC was associated with a 65% decreased likelihood of any and a 68% decreased likelihood of a major complication (OR 0.35, p<0.001 and 0.32, p<0.001 respectively). No differences in short-term pathologic outcomes (pathologic stage, positive nodes, lymph node yield and positive margin rate) were noted. CONCLUSIONS RARC is a safe procedure with benefits of reduced length of stay and decreased transfusion rates. Further gains with respect to overall and major complication rates were demonstrated in this cohort. Short-term oncologic outcomes were comparable to ORC. This large comparative series is encouraging and validates some findings of other groups and extends others suggesting the potential benefit of the robotic approach. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e710-e711 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kyle Richards Winston-Salem, NC More articles by this author A. Karim Kader San Diego, CA More articles by this author L. Spencer Krane Winston-Salem, NC More articles by this author Ashok Hemal Winston-Salem, NC More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...