title: Benefits of robotic cystectomy with intracorporeal diversion for patients with low cardiorespiratory fitness: A prospective cohort study.
abstract: Patients undergoing radical cystectomy have associated comorbidities resulting in reduced cardiorespiratory fitness. Preoperative cardiopulmonary exercise testing (CPET) measures including anaerobic threshold (AT) can predict major adverse events (MAE) and hospital length of stay (LOS) for patients undergoing open and robotic cystectomy with extracorporeal diversion. Our objective was to determine the relationship between CPET measures and outcome in patients undergoing robotic radical cystectomy and intracorporeal diversion (intracorporeal robotic assisted radical cystectomy [iRARC]).
  
  
  
  A single institution prospective cohort study in patients undergoing iRARC for muscle invasive and high-grade bladder cancer.
  
  
  
  patients undergoing standardised CPET before iRARC.
  
  
  
  patients not consenting to data collection. Data on CPET measures (AT, ventilatory equivalent for carbon dioxide [VE/VCO2] at AT, peak oxygen uptake [VO2]), and patient demographics prospectively collected. Outcome measurements included hospital LOS; 30-day MAE and 90-day mortality data, which were prospectively recorded. Descriptive and regression analyses were used to assess whether CPET measures were associated with or predicted outcomes.
  
  
  
  From June 2011 to March 2015, 128 patients underwent radical cystectomy (open cystectomy, n = 17; iRARC, n = 111). A total of 82 patients who underwent iRARC and CPET and consented to participation were included. Median (interquartile range): age = 65 (58-73); body mass index = 27 (23-30); AT = 10.0 (9-11), Peak VO2 = 15.0 (13-18.5), VE/VCO2 (AT) = 33.0 (30-38). 30-day MAE = 14/111 (12.6%): death = 2, multiorgan failure = 2, abscess = 2, gastrointestinal = 2, renal = 6; 90-day mortality = 3/111 (2.7%). AT, peak VO2, and VE/VCO2 (at AT) were not significant predictors of 30-day MAE or LOS. The results are limited by the absence of control group undergoing open surgery.
  
  
  
  Poor cardiorespiratory fitness does not predict increased hospital LOS or MAEs in patients undergoing iRARC. Overall, MAE and LOS comparable with other series.
authors.affiliation: Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK; Department of Surgery and Cancer, Centre for Patient Safety and Service Quality, Imperial College London, London, UK. Electronic address: ben.lamb@nhs.net.
authors.forename: Benjamin Wilfrid
authors.initials: BW
authors.lastname: Lamb
authors.affiliation: Division of Surgery and Interventional Science, University College London, London, UK.
authors.forename: Wei Shen
authors.initials: WS
authors.lastname: Tan
authors.affiliation: Royal Free and University College London Medical School, London, UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Eneje
authors.affiliation: Department of Anaesthesia, Royal Free Perioperative Research group, Royal Free Hospital, London, UK.
authors.forename: David
authors.initials: D
authors.lastname: Bruce
authors.affiliation: Department of Anaesthesia, Royal Free Perioperative Research group, Royal Free Hospital, London, UK.
authors.forename: Amy
authors.initials: A
authors.lastname: Jones
authors.affiliation: Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK; Cancer Research UK Beatson Institute, Glasgow, UK; Institute of Cancer Sciences, University of Glasgow, Glasgow, UK.
authors.forename: Imran
authors.initials: I
authors.lastname: Ahmad
authors.affiliation: Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
authors.forename: Ashwin
authors.initials: A
authors.lastname: Sridhar
authors.affiliation: Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
authors.forename: Hilary
authors.initials: H
authors.lastname: Baker
authors.affiliation: Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK; Department of Urology, Royal Free Hampstead NHS Foundation Trust, London, UK.
authors.forename: Tim P
authors.initials: TP
authors.lastname: Briggs
authors.affiliation: Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK; Department of Urology, Whipps Cross University Hospital, Barts Health NHS Trust, London, UK.
authors.forename: John E
authors.initials: JE
authors.lastname: Hines
authors.affiliation: Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK.
authors.forename: Senthil
authors.initials: S
authors.lastname: Nathan
authors.affiliation: Department of Anaesthesia, Royal Free Perioperative Research group, Royal Free Hospital, London, UK; UCL Division of Surgery and Interventional Science, Royal Free Hospital, London, UK.
authors.forename: Daniel
authors.initials: D
authors.lastname: Martin
authors.affiliation: Department of Anaesthesia, Royal Free Perioperative Research group, Royal Free Hospital, London, UK.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Stephens
authors.affiliation: Department of Urology, University College London Hospitals NHS Foundation Trust, London, UK; Division of Surgery and Interventional Science, University College London, London, UK.
authors.forename: John D
authors.initials: JD
authors.lastname: Kelly
mesh_terms: D000368:Aged; D000072599:Cardiorespiratory Fitness; D015653:Cystectomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D065287:Robotic Surgical Procedures; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*
keywords: Anaerobic threshold; Cardiopulmonary exercise testing; Cardiorespiratory; Complications; Length of stay; Muscle invasive; Radical cystectomy; Robotic; Urothelial carcinoma