The gold standard treatment for muscle invasive bladder cancer is radical cystectomy (RC). Robotic assisted radical cystectomy (RARC) has the benefits of decreased blood loss, lower transfusion rates, and shorter length of stay (LOS) when compared to open radical cystectomy (ORC). However, both RARC and ORC are complicated by a high rate of perioperative morbidity with a surgical site complications (SSC) rate ranging from 13-23%. In this study, they sought to determine whether the smaller incisions made during the minimally invasive RARC with intracorporeal urinary diversion (ICUD) resulted in a decreased rate of wound related complications when compared to ORC with extracorporeal urinary diversions (ECUD).
They retrospectively reviewed our institutional bladder cancer database for patients undergoing a RC and urinary diversion from 2013 to 2020. Patients were stratified by surgical technique as ORC with ECUD vs. RARC with robotic ICUD. SSC was defined as wound infection, dehiscence, and evisceration and categorized by time of occurrence within 30 days and 31-90 days. Perioperative complications were graded by the Clavien-Dindo classification. Chi-squared analysis was performed to compare the correlation between patient demographics, operative approach, and perioperative characteristics with the presence of SSC.
Of the 273 patients, 128 (46.8%) had ORC with ECUD and 145 (53.1%) had RARC with ICUD. Wound complication rates were significantly lower in patients undergoing the robotic vs. open approach for both 30 day (0.7% vs. 25.0%, p (37.5% and 42.8%, p=0.189). 83.5% of patients in both arms had an ileal conduit with the remainder being continent diversions (p=0.02).
Overall, the SSC rate was significantly lower across all wound complication subcategories (wound infection, dehiscence, and evisceration) in RARC with ICUD which may translate to better perioperative outcomes (shorter LOS and lower readmission rate) and improved patient quality of life. Further studies with larger sample sizes are needed to reinforce the findings. Moreover, in the context of the recent IROC RCT published in JAMA, these observational findings further support the utility of RARC at expert tertiary care centers.
Presented by: Carson Taber, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma,
Written by: Stephen B. Williams, MD, MBA, MS @SWilliams_MD on Twitter during the South Central Section American Urological Association Annual Meeting, September 6-10, 2022, Coronado, CA