Robot-Assisted Radical Cystectomy with Intracorporeal Urinary Diversion

Abstract

Aim: We report the oncological and functional outcomes of a population of elderly patients who underwent robotic-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion (IUD) at a single high-volume center with extensive experience in robotic surgery. Patients and Methods: Each procedure was performed by a single main surgeon, who previously attained a 30-day modified modular training program at a referring center. None technical variation was performed, and the surgical technique was performed exactly as taught. Demographics, intraoperative data, and postoperative complications were recorded for each patient of the aforementioned population. Results: From July 2015 to December 2018, we submitted to RARC with totally IUD at our institution 29 elderly patients (aged ≥75 years). Median age was 78 years (interquartile range [IQR]: 76–82). Eleven (37.9%), 12 (41.4%), and 6 (20.7%) patients received RARC with ureterocutaneostomy, ileal conduit, and orthotopic neobladder, respectively. Overall, median operative time was 360 min (IQR: 270–410). The median number of lymph node retrieved was 24 (17–34), the median intraoperative estimated blood loss (EBL) was 200 mL (150–300), with median hospitalization time of 7 days (IQR: 6–9). Each procedure was successfully completed without open conversion. A statistically significant reduction was found in the operative time, when compared to a population of younger patients (aged <75 years), probably reflecting the significant reduction in the choice of the nerve-sparing approach. Early (<30 days) and late (≥30 and <90 days) complication rates and cancer-specific mortality and overall mortality rates were not found statistically significant difference. Conclusions: In experienced hands, RARC with IUD can be safely applied to elderly patients, without a significant difference in terms of complication rates, cancer-specific survival, and overall survival.