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. 2024 Apr 28;42(1):270.
doi: 10.1007/s00345-024-04970-x.

Peri- and post-operative outcomes of robot-assisted radical cystectomy after the implementation of the EAU guidelines recommendations for collecting and reporting complications at a high-volume referral center

Franceso Pellegrino  1 , Riccardo Leni  2 , Giuseppe Basile  2 , Giuseppe Rosiello  2 , Chiara Re  2 , Pietro Scilipoti  2 , Mario De Angelis  2 , Mattia Longoni  2 , Giulio Avesani  2 , Leonardo Quarta  2 , Paolo Zaurito  2 , Francesco Cattafi  2 , Giusy Burgio  2 , Giorgio Gandaglia  2   3 , Francesco Montorsi  2   3 , Alberto Briganti  2   3 , Marco Moschini  2
Affiliations

Peri- and post-operative outcomes of robot-assisted radical cystectomy after the implementation of the EAU guidelines recommendations for collecting and reporting complications at a high-volume referral center

Franceso Pellegrino et al. World J Urol. .

Abstract

Purpose: No studies relied on a standardized methodology to collect postoperative complications after robot-assisted radical cystectomy (RARC). The aim of our study was to evaluate peri- and post-operative outcomes of patients undergoing RARC adhering to the European Association of Urology (EAU) recommendations for reporting surgical outcomes and using a long postoperative follow-up.

Materials and methods: 246 patients who underwent RARC with intracorporal urinary diversion at a single tertiary referral center with a postoperative follow-up ≥ 1 year for survivors. Postoperative outcomes were collected prospectively by interviews done by medical doctors. Complications were scored using the Clavien-Dindo classification (CD), grouped by type and severity (severe: CD score ≥ 3). We described peri- and post-operative outcomes and complication chronological distribution.

Results: Overall, 16 (6.5%) and 225 patients (91%) experienced intraoperative and postoperative complications, respectively. Moreover, 139 (57%) experienced severe complications. The most common any-grade and severe complications were infectious (72%) and genitourinary (35%), respectively. Overall, 52% of complications (358/682) occurred within 10 days from surgery, and 51% of severe complications (106/207) occurred within 35 days. However, 13% of complications (90/682) and 28% of severe complications (59/207) occurred 3 months after surgery. The earliest complications were fever of unknown origins and paralytic ileus (median time-to-complication [mTTC]: 4 days), the latest complications were urinary tract infection (mTTC: 40 days) and hydronephrosis/ureteral obstruction (mTTC: 70 days).

Conclusions: The rate of postoperative complications after RARC is > 90% when a standardized collection method and a long follow-up is implemented. These results should be used to identify potential areas of improvement and for preoperative patient counseling.

Keywords: Postoperative complications; Radical cystectomy; Robot-assisted surgery; Timing of complications; Urinary bladder neoplasms.

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