Robotic-assisted radical cystectomy: the first multicentric Brazilian experience.

The objective of this study is to report the first multicentric Brazilian series and learning curve of robotic radical cystectomy (RARC) with related intra- and postoperative outcomes. We retrospectively analyzed 37 RARC prospectively collected at four different centers in Brazil, from 2013 to 2019. We analyzed the patient's demographics, pathological tumor, and nodal status, as well as intra- and postoperative outcomes. Statistical analysis was performed with the IBM (SPSS version 25) software. Overall, 86% were male, and the median age was 69 years. 83% had muscle-invasive bladder cancer, and 17% a high-grade, recurrent non-muscle-invasive tumor. The median operative time was 420 min with 300 min as console time. Median blood loss was 350 ml and transfusion rate was 10%. In 68% of the cases, we performed an intracorporeal Bricker urinary diversion, 24% intracorporeal neobladder, and 8% ureterostomy. Six patients (16%) had a Clavien 1-2, 8% had Clavien 3, 2.5% had a Clavien 4, and 5% had Clavien 5. The median length of hospital stay was 7 days. The final pathological exam pointed out pT0 in 16%, pT1 in 8%, pT2 in 32%, ≥ pT3 in 27%, and 16% pTis. 95% had negative surgical margins. The survival at 30, 90, and 180 days was 98%, 95%, and 95%, respectively. To our knowledge, this is the first multicentric series of RARC reporting the learning curve in Brazil; even if still representing a challenging procedure, RARC could be safely and effectively faced by experienced surgeons at centers with high volumes of robotic surgery.

Journal of robotic surgery. 2020 Jan 30 [Epub ahead of print]

Marcio Covas Moschovas, Daher Cesar Chade, Marco Antonio Arap, Alvaro Sadek Sarkis, William Carlos Nahas, Luiz Henrique Rodrigues Tanure, Gustavo Ebaid, Arnaldo Jose de Carvalho Fazoli, Giuliano Betoni Guglielmetti, Carolina Bistacco, Maurício Cordeiro, Paulo Afonso, Maria Chiara Sighinolfi, Bernardo Rocco, Rafael Ferreira Coelho

Hospital 9 de Julho, São Paulo, Brazil. ., Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil., Hospital Sírio Libanês, São Paulo, Brazil., Hospital 9 de Julho, São Paulo, Brazil., Hospital das Clínicas, São Paulo, Brazil., Faculdade de Medicina do ABC, São Paulo, Brazil., University of Modena and Reggio Emilia, Modena, Italy.