title: Reoperations following Robot-Assisted Radical Cystectomy: A Decade of Experience.
abstract: There is a paucity of data regarding the operative management of complications after robot-assisted radical cystectomy. We reviewed operative management of robot-assisted radical cystectomy specific complications during our 10-year experience with this procedure and assessed the feasibility, safety and outcomes of robot-assisted reoperations.
  
  
  
  We retrospectively reviewed the records of all patients who underwent surgical interventions for robot-assisted radical cystectomy specific complications between 2005 and 2015. Univariable and multivariable logistic regression models were fit to evaluate predictors of surgical intervention after robot-assisted radical cystectomy. Kaplan-Meier curves were used to describe time to surgical interventions.
  
  
  
  A total of 92 patients (23%) underwent surgical intervention after robot-assisted radical cystectomy. Mean followup was 27 months. Average time to any surgical intervention after cystectomy was 14 months. The reoperation rate was 5%, 2% and 16% at 30, 31 to 90 and greater than 90 days, respectively. Using the Kaplan-Meier method surgical interventions occurred at a rate of 30% at 2 years and 46% at 5 years. Interventions for ureteroileal complications were the most common (48 cases) followed by interventions for bowel obstruction, fistulas and abdominal wall related complications (11 cases). Clavien 3 or greater complications and neoadjuvant chemotherapy were associated with surgical intervention.
  
  
  
  Even in experienced hands the long-term complications of robot-assisted radical cystectomy are notable. Of our patients 23% required surgical interventions after the procedure. Our initial experience with robot-assisted management of robot-assisted radical cystectomy complications appears safe and feasible, although the decision to proceed is determined primarily by surgeon experience.
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, New York; Department of Urology, Cairo University, Cairo, Egypt.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Hussein
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Zishan
authors.initials: Z
authors.lastname: Hashmi
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Seyedeh
authors.initials: S
authors.lastname: Dibaj
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Tareq
authors.initials: T
authors.lastname: Altartir
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Thomas
authors.initials: T
authors.lastname: Fiorica
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Joseph
authors.initials: J
authors.lastname: Wing
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Durrani
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: John
authors.initials: J
authors.lastname: Binkowski
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Lesley
authors.initials: L
authors.lastname: Boateng
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Gregory
authors.initials: G
authors.lastname: Wilding
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, New York. Electronic address: Khurshid.guru@roswellpark.org.
authors.forename: Khurshid A
authors.initials: KA
authors.lastname: Guru
mesh_terms: D015653:Cystectomy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007431:Intraoperative Complications / Q000453:epidemiology*; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D012086:Reoperation; D012189:Retrospective Studies; D012371:Robotics; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*
keywords: complications; cystectomy; reoperation; robotic surgical procedures; urinary bladder neoplasms