TY - JOUR
TI - Surgery-related Complications of Robot-assisted Radical Cystectomy With
Intracorporeal Urinary Diversion
AU - Schumacher, Martin C.
AU - Jonsson, Martin N.
AU - Hosseini, Abolfazl and
AU - Nyberg, Tommy
AU - Poulakis, Vassilis
AU - Pardalidis, Nikolaos P. and
AU - John, Hubert
AU - Wiklund, Peter N.
JO - European urology oncology
PY - 2011
VL - 77
TODO - 4
SP - 871-876
PB - EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC
SN - null
TODO - 10.1016/j.urology.2010.11.035
TODO - null
TODO - OBJECTIVES To assess the surgery-related complications at robot-assisted
radical cystectomy with total intracorporeal urinary diversion during
our learning curve in treating 45 patients with bladder cancer.
METHODS A total of 45 patients were pooled in 3 consecutive groups of 15
cases each to evaluate the complications according to the Clavien
classification. As a surrogate for our learning curve, the following
parameters were assessed: operative time, blood loss, urinary diversion
type, lymph node yield, surgical margin status, and length of hospital
stay.
RESULTS Early surgery-related complications were noted in 40% of the
patients and late complications in 30%. The early Clavien grade III
complications remained significant (27%) and did not decline with time.
Overall, fewer complications were observed between the groups over time,
with a significant decrease in late versus early complications (P = .005
and P = .058). The mean operative times declined from the first group to
the second and third groups (P = .005) and the hospital stays shortened
(P = .006). No significant difference was observed between groups
regarding the lymph node yield at cystectomy (P = .108), with a mean of
22.5 nodes (range 10-52) removed. More patients received an orthotopic
bladder substitute (Studer) in each of the latter 2 groups than in the
first.
CONCLUSIONS Although robot-assisted radical cystectomy with total
intracorporeal urinary diversion is a complex procedure, we observed
decreased surgery-related complications and improved outcomes over time
in the present series. Our results need to be confirmed by others before
robot-assisted radical cystectomy with totally intracorporeal urinary
diversion can be accepted as a treatment option for patients with
bladder cancer. UROLOGY 77: 871-877, 2011. (c) 2011 Elsevier Inc.
ER -