Does the presence of significant risk factors affect perioperative outcomes after robot-assisted radical cystectomy?
OBJECTIVE
To evaluate the effect of preoperative risk factors on perioperative outcomes up to 3 months after robot-assisted radical cystectomy (RARC), as RC continues to be associated with a high rate of morbidity and mortality.


METHODS
From 2005 to 2007, 66 consecutive patients had RARC at Roswell Park Cancer Institute. Patient demographics, preoperative risk factors and complications up to 3 months after RARC were reviewed from a prospective quality-assurance database. Patients were stratified into high- and low risk groups based on age, previous abdominal surgery, chronic obstructive pulmonary disease (COPD), body mass index (BMI), Revised Cardiac Risk Index (RCRI) and American Society of Anesthesiologists (ASA) score.


RESULTS
Age, previous abdominal surgery, COPD, BMI, RCRI score and ASA score did not significantly influence complications during or up to 3 months following RARC (P > 0.05). Advanced age was associated with a higher RCRI score (P = 0.014) and an increased likelihood of admission to the Intensive Care Unit (P = 0.007). A higher ASA score was associated with an increased overall hospital stay (P = 0.039). Previous abdominal surgery was associated with more frequent unscheduled postoperative clinic visits (P = 0.014). Operative duration did not significantly influence complication rates (P > 0.05). Fifteen of 62 patients (24%) had a major complication, while 15 (24%) had minor complications within 3 months of surgery. The reoperation rate was 11% and the overall mortality rate was 1.6%.


CONCLUSIONS
RARC appears to be well tolerated, independent of comorbid risk factors such as age, BMI, RCRI and ASA score.
Butt
Zubair M
ZM
Urologic Oncology, Roswell Park Cancer Institute, Buffalo, NY 14263, USA.
Fazili
Anees
A
Tan
Wei
W
Wilding
Gregory E
GE
Filadora
Victor
V
Kim
Hyung L
HL
Mohler
James L
JL
O'Leary
Kathleen A
KA
Guru
Khurshid A
KA
D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D015992:Body Mass Index; D015653:Cystectomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D007902:Length of Stay; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D011446:Prospective Studies; D012086:Reoperation; D012307:Risk Factors; D012371:Robotics; D016896:Treatment Outcome