title: Impact of tumour volume on surgical and pathological outcomes after robot-assisted radical cystectomy.
abstract: OBJECTIVE
  To report on the influence that bladder tumour volume has on operative and pathological outcomes after robotic-assisted radical cystectomy (RARC, a minimally invasive alternative to open cystectomy for treating bladder cancer), as with the lack of tactile feedback in RARC tumour volume might compromise the outcome.
  
  
  METHODS
  Between 2005 and 2007, 54 consecutive patients had RARC at one institution. CT urograms were obtained in all patients for staging purposes and to evaluate hydronephrosis. Patients were separated into two groups based on pathological tumour dimensions. Once selected into two-dimensional (2D, flat) or 3D (bulky) tumour groups the patients were compared for operative and pathological variables.
  
  
  RESULTS
  The mean age of all patients was 67 years; 19 had tumours classified as 2D and 35 as 3D. There were no statistical differences in age, sex, body mass index, American Society of Anesthesiologists score, previous surgery, mean hospital stay, or estimated blood loss between the groups. The difference in operative duration for bladder removal was almost statistically significant (P = 0.077). Intraoperative transfusion was more common in the 3D group (P = 0.044); 43% of patients in the 3D group had hydronephrosis, vs only 16% in the 2D group. 3D tumours were more likely to be higher stage (P = 0.051). All positive margins in the patient were in the 3D group (P = 0.04); no patients with < or =T2 disease had a positive surgical margin.
  
  
  CONCLUSIONS
  Bulky tumours removed with RARC might be associated with an increased rate of intraoperative transfusion, higher stage disease, and higher rate of margin positivity. In patients with large-volume tumours on preoperative assessment, wider dissection of perivesical tissue might decrease the margin-positive rates.
authors.affiliation: Department of Urology, State University of New York at Buffalo, Buffalo, New York, NY, USA.
authors.forename: Bertram
authors.initials: B
authors.lastname: Yuh
authors.forename: Joe
authors.initials: J
authors.lastname: Padalino
authors.forename: Zubair M
authors.initials: ZM
authors.lastname: Butt
authors.forename: Wei
authors.initials: W
authors.lastname: Tan
authors.forename: Gregory E
authors.initials: GE
authors.lastname: Wilding
authors.forename: Hyung L
authors.initials: HL
authors.lastname: Kim
authors.forename: James L
authors.initials: JL
authors.lastname: Mohler
authors.forename: Khurshid A
authors.initials: KA
authors.lastname: Guru
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000379:methods*; D006801:Humans; D006869:Hydronephrosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012371:Robotics; D016896:Treatment Outcome; D047368:Tumor Burden; D001743:Urinary Bladder / Q000473:pathology* / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery