MP67-18 A DECADE OF ROBOTIC CYSTECTOMY: SURGICAL CHARACTERISTICS AND ONCOLOGIC OUTCOMES

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive IV1 Apr 2015MP67-18 A DECADE OF ROBOTIC CYSTECTOMY: SURGICAL CHARACTERISTICS AND ONCOLOGIC OUTCOMES Ali Zhumkhawala, Spencer Kozinn, Kevin Chan, Clayton Lau, Nora Ruel, Jonathon Yamzon, Bertram Yuh, Mark Kawachi, and Timothy Wilson Ali ZhumkhawalaAli Zhumkhawala More articles by this author , Spencer KozinnSpencer Kozinn More articles by this author , Kevin ChanKevin Chan More articles by this author , Clayton LauClayton Lau More articles by this author , Nora RuelNora Ruel More articles by this author , Jonathon YamzonJonathon Yamzon More articles by this author , Bertram YuhBertram Yuh More articles by this author , Mark KawachiMark Kawachi More articles by this author , and Timothy WilsonTimothy Wilson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2501AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES We performed the first robotic cystectomy at our institution in 2003. Here, we present surgical and oncologic outcomes after 12 years performing this procedure. METHODS We established a prospective database to track patients undergoing robotic cystectomy who provided informed consent. Overall and disease specific survival were stratified by nodal status and pathologic stage and calculated using Kaplan-Meier analysis. RESULTS A total of 437 patients underwent robotic cystectomy between 2003 and February 2014, of whom 255 patients with a median follow up of 44 months provided informed consent for inclusion in the database. The vast majority were men (83.4%) with a median age of 70 years (IQR 63-77 years). Most patients had multiple comorbidities as demonstrated by 210 patients (82.4%) being American Society of Anesthesiologists score III or IV and median age adjusted Charlson Comorbidity Index score of 8 (IQR 5-11). Over 2/3 of patients had preoperative stage ≥cT2 with 89.8% considered high grade disease. Approximately 1/4 of patients (68 pts, 26.5%) had undergone neoadjuvant chemotherapy. Nine patients (3.5%) had previous pelvic irradiation. Median operative time was 7.2 hours (IQR 6.3-8.2) with an EBL of 387.5 mL (IQR 250-500). The most common diversion type was Studor neobladder (108 pts, 42.4%), followed by ileal conduit (88 pts, 34.5%) and Indiana pouch (58 pts, 22.7%). Nerve sparing was performed in over 1/3 of cases, either unilaterally (10 pts, 4%) or bilaterally (87 pts, 34.1%). The median length of stay was 9 days (IQR 7-13 days). 91% of patients had urothelial carcinoma, followed by adenocarcinoma (3.5%) and squamous cell carcinoma (2.4%). Positive surgical margins were rare, occurring at the bladder in 7 pts (2.7%) and urethra in 2 pts (0.8%). Final pathologic stage was ≥T2 in 62.8% of cases and 57 patients (22.4%) had lymph node positive disease. Overall and disease-specific survival were significantly worse in patients with pT3/4 disease and positive lymph nodes. (Figure 1). CONCLUSIONS Robotic cystectomy is a viable, potentially first-line, treatment option for high-risk bladder cancer. Our surgical and oncological outcomes compare well with the largest published open series. © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byChang S (2015) Re: Comparing Open Radical Cystectomy and Robot-Assisted Laparoscopic Radical Cystectomy: A Randomized Clinical TrialJournal of Urology, VOL. 194, NO. 6, (1584-1585), Online publication date: 1-Dec-2015. Volume 193Issue 4SApril 2015Page: e856-e857 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ali Zhumkhawala More articles by this author Spencer Kozinn More articles by this author Kevin Chan More articles by this author Clayton Lau More articles by this author Nora Ruel More articles by this author Jonathon Yamzon More articles by this author Bertram Yuh More articles by this author Mark Kawachi More articles by this author Timothy Wilson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...