Impact of Body Mass Index on Robotic Radical Cystectomy with Intra-Corporeal Urinary Diversion

To determine the impact of body mass index (BMI) on peri-operative and oncological outcomes following robotic radical cystectomy (RRC) with intra-corporeal urinary diversion (ICUD).

A total of 216 patients undergoing RRC, extended lymphadenectomy and ICUD (07/2010-12/2015) were categorized into four BMI groups according to the 2004 World Health Organization (WHO) obesity classification: <25 kg/m(2) (normal), 25-29. 9 kg/m(2) (pre-obese), 30-34.9 kg/m(2) (obese class I), ≥35 kg/m(2) (obese class II). Pre-, intra- and post-operative parameters, oncologic outcomes, and 90-day complications were compared using SAS statistical software.

All 216 patients underwent ICUD, with 68 (32%) undergoing orthotopic neobladder. Demographics were similar between BMI groups with regards to median age (71.8; 35-95); gender (80.6% male); CCI (66.2% 0-1); pathological stage (Cis-T2: 55.1%, T3-T4/N0: 18.5%, Tx/N+: 26.4%); median node count: 41 (IQR: 28, 53); and positive soft tissue margin rate (4.2%). Obese patients had higher blood loss and operative time (p=0.02, p=0.04, respectively). There were no significant differences in length of stay, transfusion rates, readmission, or 90-day overall and high-grade complication rates (p=0.16, p=0.96, p=0.89, p=0.22, p=0.51, respectively). At median follow-up of 13 months (15 days- 4.8 years), recurrence-free survival (p=0.92) and overall survival (p=0.68) were similar between groups.

RRC with intra-corporeal diversion is safe and feasible in obese patients with bladder cancer. BMI is not associated with significant differences in perioperative, pathological, or early oncological outcomes. This article is protected by copyright. All rights reserved.

BJU international. 2017 May 22 [Epub ahead of print]

Nariman Ahmadi, Thomas G Clifford, Gus Miranda, Jie Cai, Monish Aron, Mihir M Desai, Inderbir S Gill

USC Institute of Urology, Keck Medicine of USC, University of Southern California, Los Angeles, California.