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Review
. 2022 Sep;29(9):1002-1009.
doi: 10.1111/iju.14937. Epub 2022 May 25.

Predicting perioperative outcomes of robot-assisted radical cystectomy: Data from the Asian Robot-Assisted Radical Cystectomy Consortium

Alvin Yuanming Lee  1   2 , John Carson Allen Jr  3 , Jeremy Yuen-Chun Teoh  4   5 , Seok-Ho Kang  6 , Manish I Patel  7   8 , Satoru Muto  9 , Cheng-Kuang Yang  10 , Shingo Hatakeyama  11 , Ruiyun Zhang  12 , Kittinut Kijvikai  13 , Haige Chen  12 , Chikara Ohyama  11 , Shigeo Horie  9 , Eddie Shu-Yin Chan  4 , Lui-Shiong Lee  1   2
Affiliations
Review

Predicting perioperative outcomes of robot-assisted radical cystectomy: Data from the Asian Robot-Assisted Radical Cystectomy Consortium

Alvin Yuanming Lee et al. Int J Urol. 2022 Sep.

Abstract

Objectives: To report the perioperative outcomes of robot-assisted radical cystectomy and elucidate their risk factors.

Methods: A review of the Asian Robot-Assisted Radical Cystectomy Consortium database from 2007 to 2020 was performed. The perioperative outcomes studied included complication rates, time to solid food intake, estimated blood loss, length of hospital stay, and 30-day readmission rates.

Results: Of 568 patients, the overall complication rate was 49.2%, comprising major complications in 15.6%. Preoperative hydronephrosis was associated with an increased risk of major complications (odds ratio 3.27, 95% confidence interval 1.48-7.26, P = 0.004) while neoadjuvant chemotherapy was protective (odds ratio 0.46, 95% confidence interval 0.25-0.84, P = 0.012). The median time to solid food intake was 4 days (interquartile range 3-7) and smoking was a risk factor (odds ratio 4.28, 95% confidence interval 2.36-7.79, P < 0.001) for prolonged time to solid food intake. Median length of hospital stay was 13 days (interquartile range 9-19), and diabetes mellitus (odds ratio 1.66, 95% confidence interval 1.08-2.56, P = 0.021), neoadjuvant chemotherapy (odds ratio 2.21, 95% confidence interval 1.46-3.33, P < 0.001), and orthotopic bladder substitute creation (odds ratio 2.82, 95% confidence interval 1.90-4.18, P < 0.001) were independent risk factors for prolonged length of hospital stay. The 30-day readmission rate was 23.4% and higher in those with bilateral hydronephrosis (odds ratio 4.58, 95% confidence interval 1.97-10.65, P < 0.001) and orthotopic bladder substitute creation (odds ratio 1.87, 95% confidence interval 1.16-3.02, P = 0.010).

Conclusions: There are preoperative conditions which are significant risk factors for adverse perioperative outcomes in robot-assisted radical cystectomy. Most are potentially modifiable and can direct strategies to reduce surgical morbidity related to this major oncological procedure.

Keywords: bladder cancer; complications; perioperative outcomes; radical cystectomy; robotic surgery.

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References

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    1. Zamboni S, Soria F, Mathieu R et al. Differences in trends in the use of robot-assisted and open radical cystectomy and changes over time in peri-operative outcomes among selected centres in North America and Europe: an international multicentre collaboration. BJU Int. 2019; https://doi.org/10.1111/bju.14791.
    1. Tan YG, Allen JC, Tay KJ, Huang HH, Lee LS. Benefits of robotic cystectomy compared with open cystectomy in an enhanced recovery after surgery program: a propensity-matched analysis. Int. J. Urol. 2020; 27: 783-8.
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    1. Rai BP, Bondad J, Vasdev N et al. Robotic versus open radical cystectomy for bladder cancer in adults. Cochrane Database Syst. Rev. 2019; 4: CD011903.

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