PURPOSE - There is paucity of data regarding the operative management of complications following robot-assisted radical cystectomy (RARC). We aimed to review the operative management of RARC-specific complications during our 10-year experience of RARC, and to assess the feasibility, safety and outcomes of robot-assisted reoperations.
MATERIALS AND METHODS - We retrospectively reviewed all the patients who received surgical interventions for RARC-specific complications between 2005 and 2015. Univariable and multivariable logistic regression models were fit to evaluate predictors of receiving surgical intervention following RARC. Kaplan Meier curves were used to describe times to surgical interventions.
RESULTS - 92 patients (23%) received surgical interventions following RARC. Mean follow up was 27 months. The average time to any surgical intervention after RARC was 14 months. The reoperation rates were 5%, 2% and 16% at 30-d, 30-90-d, and >90-d respectively. Using the Kaplan Meier method, surgical interventions occurred at a rate of 30% at 2 years and 46% at 5 years. Interventions for uretero-ileal complications were the most common (n=48), followed by interventions for bowel obstruction, fistulae, and abdominal wall-related complications (n=11). Clavien ≥ 3 complications and receipt of neoadjuvant chemotherapy were associated with surgical interventions.
CONCLUSIONS - Even in experienced hands, the long term complications of RARC are notable. 23% of our patients required surgical interventions after RARC. Our initial experience with robot-assisted management of RARC complications appears safe and feasible, although the decision to proceed is determined primarily by surgeon experience.
The Journal of urology. 2015 Nov 06 [Epub ahead of print]
Ahmed A Hussein, Zishan Hashmi, Seyedeh Dibaj, Tareq Altartir, Thomas Fiorica, Joseph Wing, Mohammad Durrani, John Binkowski, Lesley Boateng, Gregory Wilding, Khurshid A Guru
Department of Urology, Roswell Park Cancer Institute, Buffalo, NY; Department of Urology, Cairo University, Egypt. , Department of Urology, Roswell Park Cancer Institute, Buffalo, NY. , Department of Urology, Roswell Park Cancer Institute, Buffalo, NY. , Department of Urology, Roswell Park Cancer Institute, Buffalo, NY. , Department of Urology, Roswell Park Cancer Institute, Buffalo, NY. , Department of Urology, Roswell Park Cancer Institute, Buffalo, NY. , Department of Urology, Roswell Park Cancer Institute, Buffalo, NY. , Department of Urology, Roswell Park Cancer Institute, Buffalo, NY. , Department of Urology, Roswell Park Cancer Institute, Buffalo, NY. , Department of Urology, Roswell Park Cancer Institute, Buffalo, NY. , Department of Urology, Roswell Park Cancer Institute, Buffalo, NY.