MP56-11 IMPACT OF TYPES OF PREVIOUS ABDOMINAL SURGERY ON PERIOPERATIVE OUTCOMES IN PATIENTS UNDERGOING ROBOTIC RADICAL CYSTECTOMY WITH INTRACORPOREAL URINARY DIVERSION

Abstract

You have accessJournal of UrologyCME1 Apr 2023MP56-11 IMPACT OF TYPES OF PREVIOUS ABDOMINAL SURGERY ON PERIOPERATIVE OUTCOMES IN PATIENTS UNDERGOING ROBOTIC RADICAL CYSTECTOMY WITH INTRACORPOREAL URINARY DIVERSION Sij Hemal, Michael Eppler, Jorge Ballon, Gus Miranda, Ryan Davis, Aref Sayegh, Jie Cai, Inderbir Gill, Monish Aron, Mihir Desai, and Giovanni Cacciamani Sij HemalSij Hemal More articles by this author , Michael EpplerMichael Eppler More articles by this author , Jorge BallonJorge Ballon More articles by this author , Gus MirandaGus Miranda More articles by this author , Ryan DavisRyan Davis More articles by this author , Aref SayeghAref Sayegh More articles by this author , Jie CaiJie Cai More articles by this author , Inderbir GillInderbir Gill More articles by this author , Monish AronMonish Aron More articles by this author , Mihir DesaiMihir Desai More articles by this author , and Giovanni CacciamaniGiovanni Cacciamani More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003309.11AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Patients with prior lower abdominal/pelvic surgery are likely to have significant post-surgical intra-abdominal adhesions that may distort the anatomy. Such a “hostile” abdomen has been considered a relative contraindication for subsequent complex robotic urologic surgery, such as robotic radical cystectomy with intracorporeal urinary diversion (RRC-ICUD). Herein, we evaluated outcomes of patients undergoing RRC-ICUD with a history of prior lower abdominal/pelvic surgery stratified by type of previous abdominal insult. METHODS: From 07/2010 to 12/2021, 445 consecutive patients underwent RRC-ICUD for bladder cancer. Patients with previous abdominal surgery (PAS) were divided into 4 cohorts by PAS type: within surgical Region of Interest (sROI); pelvic vs abdominal; major vs minor; and approach of PAS [minimally invasive (MIS) vs open]. Outcomes of interest were operative times (OTs), overall 30-day complication rate, readmission rate and genitourinary (GU) complications. Multivariate analyses assessed impact of the type of PAS on the outcomes of interest (p<0.05 significance level). RESULTS: Our cohort included a total of 445 patients: 266 with no PAS and 179 with PAS; 156 (89%) with PAS in sROI vs 19 (11%) with PAS not in sROI; 113 (64%) Major vs 63 (36%) Minor PAS; 82 (47%) with Pelvic PAS vs 93 (53%) with abdominal PAS; 22 (37%) with prior MIS vs 38 (63%) with open PAS. Oncologic outcomes: no significant differences between soft tissue positive margins amongst all 4 cohorts. Multivariate analysis: previous pelvic surgery and type of approach of PAS did not adversely impact perioperative outcomes (all p>0.05). PAS in sROI trended towards a higher overall GU complication rate (RR=3.8, p=0.08). Prior major PAS trended towards a higher 30-day complication rate (RR=1.9, p=0.06) and higher GU complication rate (RR=2.1, p=0.07). Across the models, BMI independently predicted longer OT (p=0.02)(Figure 1). CONCLUSIONS: In experienced hands, RRC-ICUD is feasible in a previously operated abdomen. However, patients with PAS in the sROI or major PAS should be counseled on a higher peri- and post-operative complication rate. Obese patients are likely to have prolonged operative times. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e778 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sij Hemal More articles by this author Michael Eppler More articles by this author Jorge Ballon More articles by this author Gus Miranda More articles by this author Ryan Davis More articles by this author Aref Sayegh More articles by this author Jie Cai More articles by this author Inderbir Gill More articles by this author Monish Aron More articles by this author Mihir Desai More articles by this author Giovanni Cacciamani More articles by this author Expand All Advertisement PDF downloadLoading ...