Lack of assocation of robotic radical cystectomy with increased incidence of local pelvic recurrence.

Abstract

e17045 Background: Robotic radical cystectomy (RRC) might be associated with an increased incidence of local pelvic recurrence and peritoneal seeding. We performed an institutional study evaluating the incidence and type of cancer recurrence following RRC. Methods: Between January 2012 and July 2019, 100 consecutive robotic radical cystectomies (RRC) were performed by a single surgeon RM. Pre-and Peri-operative characteristics were analyzed. Early and late, local and distant recurrences were studied, with the assumption that early local recurrences might suggest technical causative factors. Results: Median age was 63 ( IQR: 57-75). Male to female ratio is 2 to 1. Median BMI was 27.7 ( IQR: 24-32). 70% of patients were white, 27% were black, 2% were Hispanic, and 2% were Asians. Indications for cystectomy were refractory CIS in 6%, T disease in 26%, T2 disease in 52%, T3 disease in 5%, and T4 disease in 11%. Console time was 249 minutes ( IQR: 205-318). 70% of patients underwent ileal conduit, 30% underwent neobladder. 85% of patients underwent extended PLND and median blood loss was 150 ml, no patient required transfusion. Final pathology showed T0, Ta, CIS, T1, T2, T3, and T4 diseases in 2%, 5%, 10%, 10%, 21%, 36%, and 16% respectively. Median hospital stay was 6 days and 34% of patients had 30 days complications. 50% of patients had more than 36 months follow-up and overall, 24% of patients had cancer recurrences. Only 3 patients had recurrence within 3 months. Patient 1 had PT1, N1 disease with recurrences in common iliac lymph nodes and was treated by chemotherapy and is in complete remission. Patient 2 had pT3b N1 SCC with 3 months CT scans showing extensive pelvic and systemic recurrences and expired 6 months after surgery. Patient 3 had pT3a, N1 disease and had recurrence in the aorto-caval LN, received chemo-and immune therapy and has no evidence of disease. Conclusions: Our experience with robotic radical cystectomy did not show an increased incidence of early or local recurrence that could be attributed to the surgical approach. We believe that adherence to oncological principles is achievable with robotic approach.