NARUS 2018: Complications in robotic radical cystectomy
The oncologic principles of robotic radical cystectomy (RARC) are the same as those of open surgery. It is known that positive surgical margins (PSM) double the risk of metastatic progression, and severely worsen cancer specific survival (CSS). There are studies showing an advantage to RARC in this regard as well. The predictors of all complications include age, ASA score, pre-op hematocrit, diversion type, operative time and estimated blood loss. The prediction of major complications include Charlson comorbidity index, preop hematocrit, and diversion type (orthotopic vs. ieal coduit). Multivariable analysis has shown that specifically in RARC Charlson comorbidity score, preoperative hematocrit and type of urinary diversion are also predictors of major complications.
Most commonly seen complications of RARC include postop urinary leak, ureteral strictures, pelvic abscess, bowel complications (leak, small bowel obstruction, ileus), urosepsis, dehydration, and medical complications. In general these can all be managed robotically as well.
In summary, the robotic approach is gradually demonstrating results which are at least as good as those of open cystectomy, with similar results or better, when compared to open surgery.
Speaker: Timothy G. Wilson, John Wayne Cancer Institute, Santa Monica, CA, USA
Written By: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, at the 2018 North American Robotic Urology Symposium, February 16-17, 2018 - Las Vegas, NV