title: Robotic-assisted radical cystectomy with extracorporeal urinary diversion for urothelial carcinoma of the bladder: analysis of complications and oncologic outcomes in 175 patients with a median follow-up of 3 years.
abstract: OBJECTIVE
  To report oncologic outcomes and complications after robotic-assisted radical cystectomy (RARC).
  
  
  METHODS
  From March 2004 to August 2011, 175 consecutive patients underwent RARC with extracorporeal urinary diversion at our institution by a single surgeon. The study design was prospective. Perioperative parameters and postoperative complications were prospectively collected using the modified Clavien system. Recurrence-free survival and cancer-specific survival curves were generated using the Kaplan-Meier method.
  
  
  RESULTS
  A total of 145 men and 30 women with a median age of 73 years and a median body mass index of 27 kg/m(2) underwent RARC. Four patients (2.3%) required conversion to open surgery because of difficulty to progress. One hundred nine patients (62%) underwent a transcutaneous ileal conduit, 40 patients (23%) an orthotopic neobladder, and 26 (15%) a continent cutaneous conduit. The median operating time was 360 minutes (interquartile range [IQR]: 300-420). The median estimated blood loss was 400 mL (IQR: 250-612), with a transfusion rate of 17.0%. The median postoperative length of stay was 7.0 days (IQR: 5.2-10). Early (<30 days) and late surgery-related complications (30-90 days) occurred in 74 (42%) and 59 (34%) patients, respectively. The perioperative mortality rate was 2.8%. The positive soft tissue surgical margins rate was 5%. The median number of lymph nodes removed was 19 (IQR: 12-28). The median follow-up was 37 months (IQR: 21.5-53.5). Actuarial recurrence-free survival and cancer-specific survival at 2, 3, and 5 years after RARC were 67%, 63%, 63% and 73%, 68%, 66%, respectively.
  
  
  CONCLUSIONS
  RARC achieved mid-term oncologic efficacy. Moreover, the complication rates were comparable with open radical cystectomy series.
authors.affiliation: Department of Urology, Weill Cornell Medical College, New York, NY.
authors.forename: Evanguelos
authors.initials: E
authors.lastname: Xylinas
authors.forename: David A
authors.initials: DA
authors.lastname: Green
authors.forename: Brandon
authors.initials: B
authors.lastname: Otto
authors.forename: Asha
authors.initials: A
authors.lastname: Jamzadeh
authors.forename: Luis
authors.initials: L
authors.lastname: Kluth
authors.forename: Richard K
authors.initials: RK
authors.lastname: Lee
authors.forename: Brian D
authors.initials: BD
authors.lastname: Robinson
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Scherr
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003131:Combined Modality Therapy; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012008:Recurrence; D012371:Robotics; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000601:surgery*; D014547:Urinary Diversion