title: Oncologic, functional, and complications outcomes of robot-assisted radical cystectomy with totally intracorporeal neobladder diversion.
abstract: BACKGROUND
  Robot-assisted radical cystectomy (RARC) with totally intracorporeal neobladder diversion is a complex procedure that has been reported with good outcomes in small series.
  
  
  OBJECTIVE
  To present complications and oncologic and functional outcomes of this procedure.
  
  
  METHODS
  Between 2003 and 2012 in a tertiary referral center, 70 patients were operated on by two experienced robotic surgeons. Data were collected prospectively and reviewed retrospectively.
  
  
  METHODS
  RARC with totally intracorporeal modified Studer ileal neobladder formation.
  
  
  METHODS
  The overall outcome of RARC with a totally intracorporeal neobladder was presented by assessing (1) surgical margins, (2) recurrence or cancer-specific death at 24 mo, (3) 30-d and 90-d complications graded according to the modified Clavien-Dindo system, (4) daytime and nighttime continence (no or one pad per day) at 6 and 12 mo, and (5) satisfactory sexual activity or potency at 6 mo and 12 mo. Survival rates were estimated by Kaplan-Meier plots.
  
  
  CONCLUSIONS
  Median follow-up of the cohort was 30.3 mo (interquartile range: 12.7-35.6). We recorded negative margins in 69 of 70 patients (98.6%). Clavien 3-5 complications occurred in 22 of 70 patients (31.4%) at 30 d and 13 of 70 (18.6%) at >30 d. At 90 d, the overall complication rate was 58.5%. Clavien <3 and Clavien ≥3 complications were recorded in 15 of 70 patients (21.4%) and 26 of 70 (37.1%), respectively. Kaplan-Meier estimates for recurrence-free, cancer-specific, and overall survival at 24 mo were 80.7%, 88.9%, and 88.9%, respectively. Daytime continence and satisfactory sexual function or potency at 12 mo ranged between 70% and 90% in both men and women. Limitations of this study include its retrospective design, selection bias due to the learning curve phase, and missing data.
  
  
  CONCLUSIONS
  In this expert center for RARC, outcomes after RARC with totally intracorporeal neobladder diversion appear satisfactory and in line with contemporary open series.
authors.affiliation: Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Stavros I
authors.initials: SI
authors.lastname: Tyritzis
authors.forename: Abolfazl
authors.initials: A
authors.lastname: Hosseini
authors.forename: Justin
authors.initials: J
authors.lastname: Collins
authors.forename: Tommy
authors.initials: T
authors.lastname: Nyberg
authors.forename: Martin N
authors.initials: MN
authors.lastname: Jonsson
authors.forename: Oscar
authors.initials: O
authors.lastname: Laurin
authors.forename: Dinyar
authors.initials: D
authors.lastname: Khazaeli
authors.forename: Christofer
authors.initials: C
authors.lastname: Adding
authors.forename: Martin
authors.initials: M
authors.lastname: Schumacher
authors.forename: N Peter
authors.initials: NP
authors.lastname: Wiklund
mesh_terms: D000328:Adult; D000368:Aged; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D018450:Disease Progression; D018572:Disease-Free Survival; D053207:Diurnal Enuresis / Q000209:etiology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D053206:Nocturnal Enuresis / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D012371:Robotics; D012725:Sexual Behavior; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000401:mortality; D019738:Surgically-Created Structures; D015996:Survival Rate; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000473:pathology / Q000601:surgery*; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion / Q000009:adverse effects / Q000401:mortality
keywords: Complications; Continence; Ileal neobladder; Intracorporeal; Potency; Radical cystectomy; Recurrence; Robot assisted; Sexual function; Studer pouch; Surgical margins