Robotic-assisted radical cystectomy with extracorporeal urinary diversion for urothelial carcinoma of the bladder: analysis of complications and oncologic outcomes in 175 patients with a median follow-up of 3 years
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Robotic-assisted radical cystectomy with extracorporeal urinary diversion for urothelial carcinoma of the bladder: analysis of complications and oncologic outcomes in 175 patients with a median follow-up of 3 years. / Xylinas, Evanguelos; Green, David A; Otto, Brandon; Jamzadeh, Asha; Kluth, Luis; Lee, Richard K; Robinson, Brian D; Shariat, Shahrokh F; Scherr, Douglas S.
In: UROLOGY, Vol. 82, No. 6, 01.12.2013, p. 1323-9.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Robotic-assisted radical cystectomy with extracorporeal urinary diversion for urothelial carcinoma of the bladder: analysis of complications and oncologic outcomes in 175 patients with a median follow-up of 3 years
AU - Xylinas, Evanguelos
AU - Green, David A
AU - Otto, Brandon
AU - Jamzadeh, Asha
AU - Kluth, Luis
AU - Lee, Richard K
AU - Robinson, Brian D
AU - Shariat, Shahrokh F
AU - Scherr, Douglas S
N1 - Copyright © 2013 Elsevier Inc. All rights reserved.
PY - 2013/12/1
Y1 - 2013/12/1
N2 - OBJECTIVE: To report oncologic outcomes and complications after robotic-assisted radical cystectomy (RARC).MATERIALS AND METHODS: From March 2004 to August 2011, 175 consecutive patients underwent RARC with extracorporeal urinary diversion at our institution by a single surgeon. The study design was prospective. Perioperative parameters and postoperative complications were prospectively collected using the modified Clavien system. Recurrence-free survival and cancer-specific survival curves were generated using the Kaplan-Meier method.RESULTS: A total of 145 men and 30 women with a median age of 73 years and a median body mass index of 27 kg/m(2) underwent RARC. Four patients (2.3%) required conversion to open surgery because of difficulty to progress. One hundred nine patients (62%) underwent a transcutaneous ileal conduit, 40 patients (23%) an orthotopic neobladder, and 26 (15%) a continent cutaneous conduit. The median operating time was 360 minutes (interquartile range [IQR]: 300-420). The median estimated blood loss was 400 mL (IQR: 250-612), with a transfusion rate of 17.0%. The median postoperative length of stay was 7.0 days (IQR: 5.2-10). Early (<30 days) and late surgery-related complications (30-90 days) occurred in 74 (42%) and 59 (34%) patients, respectively. The perioperative mortality rate was 2.8%. The positive soft tissue surgical margins rate was 5%. The median number of lymph nodes removed was 19 (IQR: 12-28). The median follow-up was 37 months (IQR: 21.5-53.5). Actuarial recurrence-free survival and cancer-specific survival at 2, 3, and 5 years after RARC were 67%, 63%, 63% and 73%, 68%, 66%, respectively.CONCLUSION: RARC achieved mid-term oncologic efficacy. Moreover, the complication rates were comparable with open radical cystectomy series.
AB - OBJECTIVE: To report oncologic outcomes and complications after robotic-assisted radical cystectomy (RARC).MATERIALS AND METHODS: From March 2004 to August 2011, 175 consecutive patients underwent RARC with extracorporeal urinary diversion at our institution by a single surgeon. The study design was prospective. Perioperative parameters and postoperative complications were prospectively collected using the modified Clavien system. Recurrence-free survival and cancer-specific survival curves were generated using the Kaplan-Meier method.RESULTS: A total of 145 men and 30 women with a median age of 73 years and a median body mass index of 27 kg/m(2) underwent RARC. Four patients (2.3%) required conversion to open surgery because of difficulty to progress. One hundred nine patients (62%) underwent a transcutaneous ileal conduit, 40 patients (23%) an orthotopic neobladder, and 26 (15%) a continent cutaneous conduit. The median operating time was 360 minutes (interquartile range [IQR]: 300-420). The median estimated blood loss was 400 mL (IQR: 250-612), with a transfusion rate of 17.0%. The median postoperative length of stay was 7.0 days (IQR: 5.2-10). Early (<30 days) and late surgery-related complications (30-90 days) occurred in 74 (42%) and 59 (34%) patients, respectively. The perioperative mortality rate was 2.8%. The positive soft tissue surgical margins rate was 5%. The median number of lymph nodes removed was 19 (IQR: 12-28). The median follow-up was 37 months (IQR: 21.5-53.5). Actuarial recurrence-free survival and cancer-specific survival at 2, 3, and 5 years after RARC were 67%, 63%, 63% and 73%, 68%, 66%, respectively.CONCLUSION: RARC achieved mid-term oncologic efficacy. Moreover, the complication rates were comparable with open radical cystectomy series.
KW - Adult
KW - Aged
KW - Aged, 80 and over
KW - Combined Modality Therapy
KW - Cystectomy
KW - Female
KW - Humans
KW - Kaplan-Meier Estimate
KW - Lymph Node Excision
KW - Male
KW - Middle Aged
KW - Postoperative Complications
KW - Recurrence
KW - Robotics
KW - Treatment Outcome
KW - Urinary Bladder Neoplasms
KW - Urinary Diversion
U2 - 10.1016/j.urology.2013.07.048
DO - 10.1016/j.urology.2013.07.048
M3 - SCORING: Journal article
C2 - 24295248
VL - 82
SP - 1323
EP - 1329
JO - UROLOGY
JF - UROLOGY
SN - 0090-4295
IS - 6
ER -
