Benefits of robotic cystectomy with intracorporeal diversion for patients with low cardiorespiratory fitness: A prospective cohort study

Patients undergoing radical cystectomy have associated comorbidities resulting in reduced cardiorespiratory fitness. Preoperative cardiopulmonary exercise testing (CPET) measures including anaerobic threshold (AT) can predict major adverse events (MAE) and hospital length of stay (LOS) for patients undergoing open and robotic cystectomy with extracorporeal diversion. Our objective was to determine the relationship between CPET measures and outcome in patients undergoing robotic radical cystectomy and intracorporeal diversion (intracorporeal robotic assisted radical cystectomy [iRARC]).

A single institution prospective cohort study in patients undergoing iRARC for muscle invasive and high-grade bladder cancer. Inclusion: patients undergoing standardised CPET before iRARC.

patients not consenting to data collection. Data on CPET measures (AT, ventilatory equivalent for carbon dioxide [VE/VCO2] at AT, peak oxygen uptake [VO2]), and patient demographics prospectively collected. Outcome measurements included hospital LOS; 30-day MAE and 90-day mortality data, which were prospectively recorded. Descriptive and regression analyses were used to assess whether CPET measures were associated with or predicted outcomes.

From June 2011 to March 2015, 128 patients underwent radical cystectomy (open cystectomy, n = 17; iRARC, n = 111). A total of 82 patients who underwent iRARC and CPET and consented to participation were included. Median (interquartile range): age = 65 (58-73); body mass index = 27 (23-30); AT = 10.0 (9-11), Peak VO2 = 15.0 (13-18.5), VE/VCO2 (AT) = 33.0 (30-38). 30-day MAE = 14/111 (12.6%): death = 2, multiorgan failure = 2, abscess = 2, gastrointestinal = 2, renal = 6; 90-day mortality = 3/111 (2.7%). AT, peak VO2, and VE/VCO2 (at AT) were not significant predictors of 30-day MAE or LOS. The results are limited by the absence of control group undergoing open surgery.

Poor cardiorespiratory fitness does not predict increased hospital LOS or MAEs in patients undergoing iRARC. Overall, MAE and LOS comparable with other series.

Urologic oncology. 2016 May 16 [Epub ahead of print]

Benjamin Wilfrid Lamb, Wei Shen Tan, Philip Eneje, David Bruce, Amy Jones, Imran Ahmad, Ashwin Sridhar, Hilary Baker, Tim P Briggs, John E Hines, Senthil Nathan, Daniel Martin, Robert C Stephens, John D Kelly

Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK; Department of Surgery and Cancer, Centre for Patient Safety and Service Quality, Imperial College London, London, UK. Electronic address: ., Division of Surgery and Interventional Science, University College London, London, UK., Royal Free and University College London Medical School, London, UK., Department of Anaesthesia, Royal Free Perioperative Research group, Royal Free Hospital, London, UK., Department of Anaesthesia, Royal Free Perioperative Research group, Royal Free Hospital, London, UK., Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK; Cancer Research UK Beatson Institute, Glasgow, UK; Institute of Cancer Sciences, University of Glasgow, Glasgow, UK., Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK., Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK., Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK; Department of Urology, Royal Free Hampstead NHS Foundation Trust, London, UK., Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK; Department of Urology, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK., Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK., Department of Anaesthesia, Royal Free Perioperative Research group, Royal Free Hospital, London, UK; UCL Division of Surgery and Interventional Science, Royal Free Hospital, London, UK., Department of Anaesthesia, Royal Free Perioperative Research group, Royal Free Hospital, London, UK., Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK.

E-Newsletters

Newsletter subscription

Free Daily and Weekly newsletters offered by content of interest

The fields of GU Oncology and Urology are rapidly advancing. Sign up today for articles, videos, conference highlights and abstracts from peer-review publications by disease and condition delivered to your inbox and read on the go.

Subscribe