Evaluation of peri-operative complications and outcomes of robot-assisted radical nephroureterectomy and bladder cuff excision in a tertiary center

Abstract

ObjectiveFor patients with localized upper tract urothelial carcinoma (UTUC), radical nephroureterectomy with ipsilateral bladder cuff excision (RNU + BCE) is the standard treatment. In recent years, robot-assisted RNU with BCE (RaRNU + BCE) has been another choice of surgical intervention. This article was aimed to analyze the efficacy and peri-operative outcomes regarding RaRNU + BCE via a single institutional experience. Materials and methodsFrom March 2012 to November 2015, total 54 patients with UTUC were treated with RaRNU + BCE at Taipei Veterans General Hospital. We collected demographic data, histopathological reports, peri-operative complications and oncologic outcomes. ResultsTotal 54 patients were included in our study. The mean age was 71.9 ± 9.9 (range 48–88) and the mean body mass index was 23.5 ± 2.9 (range 16.4–30.8). The mean operating time was 314 min (RaRNU: 133.9 ± 41.4 min, RaBCE: 72.9 ± 25.7 min). The mean first docking time was 26.8 ± 7.7 min and the mean second docking time was 16.5 ± 6.7 min. The mean EBL was 87.7 ml. Pathological stage distribution was 22.2%, 27.8%, 13.0%, 31.5% and 5.6% in pTa, pT1, pT2, pT3 and pT4, respectively. Complications occurred in 7 cases (13%), with 4 grade I and 3 grade II by Clavien-Dindo classification. Positive tumor involvement at bladder cuff was noted in 3 patients, and the bladder recurrence rate was 29.6%. Local recurrence, lymph node metastasis, and distant metastasis were all noted for 2 patients respectively. The cancer-specific and overall survival rate was 98.1% and 96.3%. ConclusionOur experience showed RaRNU + BCE is an technically feasible and safe procedure for selected patients with UTUC.