Abstract
Introduction and objectivesTo evaluate late complications in a large cohort of patients undergoing robot-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion (ICUD).Materials and methodsWe prospectively enrolled patients who underwent RARC and ICUD between August 2012 and June 2019. We excluded patients with Ejection fraction < 36%, retinal vasculopathy, ventriculoperitoneal shunts, and those treated without curative intent. All complications and their onset date have been recorded, defined, and graded according to Clavien classification adapted for radical cystectomy.Results210 patients were included, 76% of whom were men, with a mean age of 62 years. Urinary diversions used were Padua Ileal Bladder (PIB) in 80% of cases, and ileal conduit (IC) in 20% of patients (generally older and with more comorbidity). The mean follow-up was 30 ± 22 months. The stenosis rate of uretero-ileal anastomosis was 14%, while a reduction in eGFR (≥ 20%) was observed in about half of the cases. UTIs occurred in 37% of the patients, especially in the first 12 months. Only 2% of patients had bowel occlusion, whereas incisional hernia, lymphocele, and systemic events (metabolic acidosis and major cardiovascular events) occurred respectively in 20%, 10%, and 1% of cases.ConclusionsOur study evaluates first late complications in a cohort of patients who underwent RARC with ICUD. These data are encouraging and in line with findings from a historical series of open radical cystectomy (ORC). This study is a further step in supporting RARC as a safe and effective surgical option for the treatment of muscle-invasive bladder cancer (MIBC) in tertiary referral centers.
Highlights
Introduction and objectivesTo evaluate late complications in a large cohort of patients undergoing robot-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion (ICUD)
Possible complications were collected at each follow-up visit and all patients enrolled in the study had completed monitoring for at least 90 days after surgery, as we considered all those that occurred after 90 days from surgery as late complications
We first reported the incidence of late complications following RARC with ICUD
Summary
Open radical cystectomy (ORC) is still the standard treatment for MIBC and recurrent high-grade NMIBC [1]. Over the last decade, robot-assisted radical cystectomy (RARC) has gradually gained popularity as a possible. There is an increasing interest in RARC and several publications that have been published on this topic in recent years, it is not yet possible to draw definitive conclusions on the advantages and possible limitations of the robotic approach with respect to the open technique [1,2,3,4,5]. As mentioned in the guidelines of the European Society of Urology (EAU), there are no available studies on late complications of RARC performed with totally intracorporeal urinary derivations (ICUD) [1]. Aim of our study was to evaluate, for the first time in the literature, late complications in a large cohort of patients undergoing RARC with totally intracorporeal urinary diversion (ICUD)
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