Robotic-assisted radical cystectomy: Experiences of a from a high-volume robotic prostatectomy surgeon
Raees Cassim1, Yanbo Guo1, Jen Hoogenes1, Bobby Shayegan1.
1Division of Urology, McMaster, Hamilton, ON, Canada
Introduction: The recently published RAZOR trial demonstrated non-inferiority of robotic-assisted radical cystectomy (RARC) compared to open cystectomy.1 While gaining popularity in the U.S., few centers in Canada use this technique. This may be related to the perceived challenges and learning curve of this procedure. We present outcomes from the largest Canadian cohort of RARC performed at a tertiary site with extensive robotic prostatectomy experience.
Methods: We conducted a retrospective chart review of all patients undergoing RARC at our institution from May 2020 to December 2021. These were performed by a single surgeon (BS). We collected information regarding patient demographics, intraoperative and postoperative factors, and complications in the first 90 days. Regression analysis was used to determine the relationship between case volume and operative time/lymph node yield.
Results: A total of 31 patients underwent RARC in our study period (Table 1). For ileal conduit diversions, decreasing operative time was weakly correlated with increased case volumes, whereas neobladder operative times were not (Figure 1). Median length of stay was six days (Figure 2). Surgical margins were positive in 12.9% (n=4) of patients. Average lymph node yield was 17.8±7.5 nodes and was not significantly affected by case volume (Figure 3). Forty-five percent (n=14) of patients were managed without an epidural or patient-controlled analgesia. Forty-five percent (n=14) of patients experienced postoperative complications, with only 12.9% (n=4) experiencing Clavien-Dindo grade 3 or greater complications. Two patients received intraoperative transfusions and two patients received postoperative transfusions. Reoperation rate was 3.2%. Ninety-day readmission and mortality rates were 17.2% (n=5) and 0%, respectively
Conclusions: RARC, when conducted by an experienced robotic pelvic surgeon, is safe and provides satisfactory oncological outcomes. Prior experience with robotic pelvic surgery may have avoided a noticeable learning curve at our facility.
[1] Parekh DJ, Reis IM, Castle EP, Gonzalgo ML, Woods ME, Svatek RS, et al. Robot-assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer (RAZOR): an open-label, randomised, phase 3, non-inferiority trial. The Lancet. 2018 Jun 23;391(10139):2525–36.
