Robot-assisted radical cystectomy and intracorporeal neobladder formation: on the way to a standardized procedure

World Journal of Surgical Oncology

Abdullah Erdem Canda¹  Georgios Gakis²  Arnulf Stenzl²  Simone Bier²  Steffen Rausch²  Johannes Böttge²  Johannes Mischinger²  Omar Halalsheh²  Stefan Aufderklamm²  Tilman Todenhöfer²  Mevlana Derya Balbay³  Allen Sim²  Christian Schwentner² 

[1] Department of Urology, Ankara Atatürk Training & Research Hospital, Ankara, Turkey;Department of Urology, Eberhard-Karls University, Hoppe-Seyler Str. 3, 72076 Tübingen, Germany;Department of Urology, Memorial Şişli Hospital, Istanbul, Turkey

关键词: robot-assisted;    radical cystectomy;    neobladder;    laparoscopy;    intracorporeal diversion;   

Others  :  1146572
DOI  :  10.1186/1477-7819-13-3

 received in 2014-06-17, accepted in 2014-12-13,  发布年份 2015

【 摘 要 】

Background

Robot-assisted radical cystectomy (RARC) with intracorporeal diversion has been shown to be feasible in a few centers of excellence worldwide, with promising functional and oncologic outcomes. However, it remains unknown whether the complexity of the procedure allows its duplication in other non-pioneer centers. We attempt to address this issue by presenting our cumulative experience with RARC and intracorporeal neobladder formation.

Methods

We retrospectively identified 62 RARCs in 50 men and 12 women (mean age 63.6 years) in two tertiary centers. Intracorporeal Studer neobladders were created, duplicating the steps of standard open surgery. Perioperative and postoperative variables and complications were analyzed using standardized tools. Functional and oncological results were assessed.

Results

The mean operative time was 476.9 min (range, 310 to 690) and blood loss was 385 ml (200 to 800). The mean hospital stay was 16.7 (12 to 62) days with no open conversion. Perioperative complications were grade II in 15, grade III in 11, and grade IV in 5 patients. The mean nodal yield was 22.9 (8 to 46). Positive margins were found in in 6.4%. The 90- and 180-day mortality rates were 0% and 3.3%. The average follow-up was 37.3 months (3 to 52). Continence was achieved in 88% of patients. The cancer-specific survival rate and overall survival rate were 84% and 71%, respectively.

Conclusions

A RARC with intracorporeal neobladder creation is safe and reproducible in ‘non-pioneer’ tertiary centers with robotic expertise with acceptable operative time and complications. Further standardization of RARC with intracorporeal diversion is a prerequisite for its widespread use.

【 授权许可】

   
2015 Schwentner et al.; licensee BioMed Central.

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