title: [Treatment of invasive bladder cancer: robot-assisted radical cystectomy and intracorporeal urinary diversion].
abstract: OBJECTIVE
  Robot-assisted radical cystectomy (RARC) and intracorporeal urinary diversion are only performed in a few centers of excellence worldwide. Functional and oncologic outcomes are comparable. We report on our experience with RARC and intracorporeal diversion.
  
  
  METHODS
  We retrospectively identified 86 RARCs in 72 men and 14 women (mean age 69.7 years). All patients underwent robot-assisted radical cystectomy and pelvic lymphadenectomy followed by intracorporeal urinary diversion using ileal conduit or neobladder. Of the 86 patients, 24 patients (28%) underwent intracorporeal ileal conduit and 62 patients (72%) underwent intracorporeal neobladder formation. A Studer pouch was created in all who underwent intracorporeal neobladder diversion. Cancer specific survival (CSS) and overall survival (OS) are reported.
  
  
  RESULTS
  The mean operative time was 418.9 min (range 205-690 min) and blood loss was 380 ml (range 100-1000 ml). The mean hospital stay was 17.5 days (range 5-62 days). All the surgeries were completed with no open conversions. Minor complications (grade I and II) were reported in 23 patients, while major complications (grade III and above) were reported in 21 patients. The mean nodal yield was 20.3 (range 0-46). Positive margins were found in in 8%. The average follow-up was 31.5 months (range 3-52 months). Continence could be achieved in 88% of patients who received an intracorporeal neobladder. The cancer-specific survival (CSS) and overall survival (OS) were 80% and 70%, respectively.
  
  
  CONCLUSIONS
  RARC with intracorporeal diversion seems to be safe and reproducible in tertiary centers with robotic expertise. Operative times are acceptable and complications as well as functional and oncologic outcomes are comparable. Further standardization of RARC with intracorporeal diversion may lead to a wider adoption of the approach.
authors.affiliation: Klinik für Urologie, Eberhard-Karls Universität Tübingen, Hoppe-Seyler Straße 3, 72076, Tübingen, Deutschland.
authors.forename: S
authors.initials: S
authors.lastname: Bier
authors.forename: A
authors.initials: A
authors.lastname: Sim
authors.forename: D
authors.initials: D
authors.lastname: Balbay
authors.forename: T
authors.initials: T
authors.lastname: Todenhöfer
authors.forename: S
authors.initials: S
authors.lastname: Aufderklamm
authors.forename: O
authors.initials: O
authors.lastname: Halalsheh
authors.forename: J
authors.initials: J
authors.lastname: Mischinger
authors.forename: J
authors.initials: J
authors.lastname: Böttge
authors.forename: S
authors.initials: S
authors.lastname: Rausch
authors.forename: A
authors.initials: A
authors.lastname: Stenzl
authors.forename: G
authors.initials: G
authors.lastname: Gakis
authors.forename: E
authors.initials: E
authors.lastname: Canda
authors.forename: C
authors.initials: C
authors.lastname: Schwentner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000401:mortality*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000401:mortality*; D015996:Survival Rate; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy*; D014547:Urinary Diversion / Q000401:mortality*