Robot-assisted intracorporeal orthotopic bladder substitution after radical cystectomy: perioperative morbidity and oncological outcomes - a single institution experience.

To report a single institution experience with totally intracorporeal neobladder urinary diversion after robot-assisted laparoscopic radical cystectomy (RARC).

A total of 158 patients underwent totally intracorporeal neobladder urinary diversion after RARC between 2003 - 2016. Patient demographics, intraoperative- and pathologic data, 30-d and 90-d perioperative mortality and complications were recorded. Complications were classified according to the modified Clavien-Dindo classification. Five year overall and disease-specific survival rates were estimated by Kaplan-Meier plots.

The majority of the patients were male (84%) and had clinically T-stage ≤2 (87%). Mean operation time was 359 min (SD ±98) with a median estimated blood loss of 300ml (50-2200). Most of the men (86%) received a nerve-sparing procedure and 38% of the females an organ-sparing approach. A lymph node dissection was performed in 156 (99%) cases with a median yield of 23 (7-48). Conversion to open surgery occurred in 5 patients (3%). We recorded negative margins in 156 patients (99%). Median follow-up time was 34 months (1-170) with a 30-d and 90-d mortality rate of 0%. Clavien III-IV complications occurred in 29 of 158 (18%) patients at 30-d and in 8 of 158 (5%) between 30-90d resulting into a 90-d overall high-grade complication rate of 23%. The unadjusted estimated 5y recurrence-free (RFS), cancer specific (CSS) and overall survival (OS) rates were 70%, 72%, and 71%, respectively.

In our series, the complication and oncologic results were similar to open radical cystectomy series, suggest that RARC followed by totally intracorporeal neobladder urinary diversion is a safe and feasible alternative.

BJU international. 2020 May 13 [Epub ahead of print]

Abolfazl Hosseini, Ashkan Mortezavi, Siri Sjöberg, Oscar Laurin, Christofer Adding, Justin Collins, Peter N Wiklund

Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden.