Surgical and pathological outcomes of robotic-assisted radical cystectomy for bladder cancer in the community setting

Surgical and pathological outcomes of robotic-assisted radical cystectomy for bladder cancer in... Robotic-assisted radical cystectomy (RARC) with urinary diversion is commonly performed in community hospitals. While little data exist on RARC outcomes in this setting, community hospitals may improve access to care for bladder cancer patients. We conducted a retrospective review of 76 patients who underwent RARC between 2006 and 2016 by two robotic-trained surgeons in two local community hospitals. A total of 76 patients (60 males and 16 females; ages 46–89) underwent RARC with extended pelvic lymphadenectomy and urinary diversion (69 ileal conduits, 7 neobladders) for muscle-invasive bladder carcinoma (79%), recurrent high-grade carcinoma (17%), unresectable tumor (2%), or refractory gross hematuria from chemotherapy (2%). Median-estimated surgical blood loss (EBL) was 400 mL, and median operating time was 386 min. Transfusion rate was 22% and median length of hospital stay was 6 days. Our 90-day complication rate was 47%, with no mortalities in the 90-day post-operative period. The majority of complications (58%) were Clavien grade 1–2. We observed a significant difference in incidence of complications among patients receiving neobladder vs. ileal conduit (p = 0.002). On pathology, zero patients had positive bladder specimen margins. Among 28 patients with at least 3-year follow-up, overall survival was 85.7%, and among 9 patients with at least 5-year follow-up, overall survival was 100%. Contrary to some studies, our findings suggest similar short-term surgical and pathologic outcomes for RARC performed in the community hospital setting compared to high volume centers. We defined several criteria for low volume centers to effectively and safely perform RARC. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Robotic Surgery Springer Journals

Surgical and pathological outcomes of robotic-assisted radical cystectomy for bladder cancer in the community setting

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Publisher
Springer London
Copyright
Copyright © 2017 by Springer-Verlag London Ltd.
Subject
Medicine & Public Health; Minimally Invasive Surgery; Surgery; Urology
ISSN
1863-2483
eISSN
1863-2491
D.O.I.
10.1007/s11701-017-0740-y
Publisher site
See Article on Publisher Site

Abstract

Robotic-assisted radical cystectomy (RARC) with urinary diversion is commonly performed in community hospitals. While little data exist on RARC outcomes in this setting, community hospitals may improve access to care for bladder cancer patients. We conducted a retrospective review of 76 patients who underwent RARC between 2006 and 2016 by two robotic-trained surgeons in two local community hospitals. A total of 76 patients (60 males and 16 females; ages 46–89) underwent RARC with extended pelvic lymphadenectomy and urinary diversion (69 ileal conduits, 7 neobladders) for muscle-invasive bladder carcinoma (79%), recurrent high-grade carcinoma (17%), unresectable tumor (2%), or refractory gross hematuria from chemotherapy (2%). Median-estimated surgical blood loss (EBL) was 400 mL, and median operating time was 386 min. Transfusion rate was 22% and median length of hospital stay was 6 days. Our 90-day complication rate was 47%, with no mortalities in the 90-day post-operative period. The majority of complications (58%) were Clavien grade 1–2. We observed a significant difference in incidence of complications among patients receiving neobladder vs. ileal conduit (p = 0.002). On pathology, zero patients had positive bladder specimen margins. Among 28 patients with at least 3-year follow-up, overall survival was 85.7%, and among 9 patients with at least 5-year follow-up, overall survival was 100%. Contrary to some studies, our findings suggest similar short-term surgical and pathologic outcomes for RARC performed in the community hospital setting compared to high volume centers. We defined several criteria for low volume centers to effectively and safely perform RARC.

Journal

Journal of Robotic SurgerySpringer Journals

Published: Aug 23, 2017

References

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