The Effect of Complexity of the Surgical Field on Perioperative Outcomes of Robot-Assisted Radical Cystectomy

Abstract

ObjectiveTo report the outcomes of patients who underwent robot-assisted radical cystectomy (RARC) and have a history of previous pelvic surgery and/or radiation. MethodsRetrospective review of our prospectively maintained database between 2005 and 2018. Patients were divided into 3 groups based on surgical complexity; Complexity grade 1 included patients who did not have any history of prior pelvic surgery or radiation (n = 323); Complexity grade 2 included those who had history of a single pelvic surgery or radiation (n = 186); and Complexity grade 3 included those who had history of 2 or more pelvic surgeries, or one or more pelvic surgery and radiation (n = 80). All groups were compared in terms of perioperative outcomes. Multivariate linear and logistic regression models were used to depict the predictors of operative time, ≥500 ml blood loss, 90-day complications, high grade complications, and readmissions. ResultsComplexity grades 2 and 3 exhibited higher 90-day complications compared to CG1 (CG3: 74%, CG1: 59%, CG2: 68%, P = .02), and high grade complications (CG3: 24%, CG1: 13%, CG2 18%, P = .03). On multivariate linear and logistic regression models, CG 3 was significantly associated with higher 90-day complications (OR 2.18, 95% CI 1.21-3.94, P <.01) but not significantly associated with higher rates of significant blood loss, longer operative time, 90-day high grade complications and readmissions. ConclusionPatients with higher complexity of the surgical field exhibited more complications after robot-assisted radical cystectomy, but not readmissions.