Evolution of cystectomy care over a 11-years period in a high volume tertiary referral center

To describe the evolution RC care over 11 years in a referral center.

Clinical data of patients undergoing either open RC (ORC) or robot-assisted RC (RARC) for cT1-4aN0M0 bladder cancer (BCa) at our center between 01/2006 and 12/2016 were retrospectively evaluated. Crude and propensity score weighted log-binomial regression analyses assessed the association between pre-/perioperative variables and the risk of reoperation, intensive care unit (ICU) admission and death within 90 days after RC.

814 patients were considered. The percentage of RARC increased (10%-100%) from 2006 to 2013. Overall, 29% of the patients received neoadjuvant chemotherapy (12-37% from 2006 to 2016). Despite no differences in terms of operation time (OT), lymph node dissection (LND) was more commonly attempted during RARC and it was more frequently "Extended" (72% vs 19%; p < 0.001). Ileal conduit was the preferred urinary diversion in both groups: more patients in the robotic cohort received neobladder (34% vs 14%; p<0.001). The overall rates of re-intervention, ICU admission and death within 90 days after RC were 8.9%, 5.4% and 2.9%, respectively. On crude analysis, RARC was associated with a reduced risk of ICU admission (RR = 0.42; 95% CI 0.23-0.77; p = 0.005), reintervention (RR = 0.58; 95% CI 0.37-0.90; p = 0.015) and death (RR = 0.37; 95% CI 0.16-0.85; p = 0.020); these risk reductions, however, were not statistically significant at weighted analyses.

the introduction of RARC has coincided with a reduction in the rate of ICU admission, re-operation and death within 90 days after surgery, without compromising OT, LND extent and neobladder utilization. This article is protected by copyright. All rights reserved.

BJU international. 2017 Dec 27 [Epub ahead of print]

Aldo Brassetti, Axel Möller, Oscar Laurin, Jonas Höijer, Christofer Adding, Ayako Miyakawa, Abolfazl Hosseini, Peter Wiklund

Department of Molecular Medicine and surgery section of Urology, Karolinska Institutet, Stockholm, Sweden., Unit of Biostatistics Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.