To report on patients undergoing robotic-assisted partial cystectomy (RAPC), focusing on perioperative outcomes over a range of clinical, anatomic and pathologic variables as well as the overall oncological efficacy of this approach.
We retrospectively reviewed all patients who underwent robotic assisted partial cystectomy (RAPC) by a single surgeon between 2005-2015. We identified 29 patients who underwent surgery for definitive management of a primary bladder tumor. Clinicopathologic data and perioperative variables were recorded. Continuous variables were compared using student's t-test. Prediction of perioperative outcomes for those undergoing RAPC for intradiverticular neoplasms was done using univariable logistic regression. Survival was estimated using the Kaplan-Meier method.
Median patient age was 75 years [IQR 65-81], 18 patients (62.1%) had an ASA classification of 3 or higher, and 10 patients (34.5%) had a history of prior abdominal surgery. Median blood loss was 50 cc and median length of stay was 1 day. Two patients (6.9%) experienced a perioperative complication and five (17.9%) a post-discharge 90 day complication, all which were minor. Positive surgical margin rate was 3.6%, and in those with muscle invasive disease a median of 12 lymph nodes were removed. Neither size of diverticulum or need for ureteral reimplant were predictive of length of stay, blood loss, or complication (p>0.05). We did not encounter any wound, port site, or unusual recurrence patterns to suggest the technical factors of a robotic approach influenced oncologic outcomes. Five-year overall and recurrence-free survival rates were 79% and 68% respectively.
RAPC confers the ability to achieve favorable outcomes with low morbidity and reduced hospital stays. Oncological efficacy compares favorably with published literature. For experienced surgeons, this may represent the optimal surgical approach for organ preserving bladder surgery. This article is protected by copyright. All rights reserved.
BJU international. 2016 May 21 [Epub ahead of print]
David M Golombos, Padraic O'Malley, Patrick Lewicki, Benjamin V Stone, Douglas S Scherr
Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College, New York., Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College, New York., Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College, New York., Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College, New York., Department of Urology, New York Presbyterian Hospital, Weill Cornell Medical College, New York.