Korean J Urol.  2015 Jan;56(1):48-55. 10.4111/kju.2015.56.1.48.

Standardized analysis of complications after robot-assisted radical cystectomy: Korea University Hospital experience

• Pyun JH
• Kim HK
• Kim JY
• Kim SB
• Cho S
• Kang SG
• Ko YH
• Cheon J
• Lee JG
• Kim JJ
• Kang SH

• KMID: 2070268
• DOI: http://doi.org/10.4111/kju.2015.56.1.48

Abstract

PURPOSE
To analyze the complications after robot-assisted radical cystectomy (RARC) by use of a standardized reporting methodology by a single surgeon.
MATERIALS AND METHODS
We prospectively reviewed a maintained institutional database of 52 patients who underwent RARC to manage bladder cancer and were followed up in 3 months by a single surgeon at Korea University Medical Center from 2007 through 2014. All complications within 90 days of surgery were defined and categorized into 5 grades according to the Clavien-Dindo classification. Logistic regression analysis was used to identify predictors of complications.
RESULTS
Fifty percent of patients (26 of 52) experienced a complication of any grade <90 days after surgery, and 11 patients (21.2%) experienced a major complication. Complications were grouped in systems-based categories. Fifty complications occurred in 52 patients and hematologic complication (transfusion) was the most common (13 of 52). Wound dehiscence, anastomotic leakage, urinary tract obstruction, mechanical obstruction, and thromboembolism occurred as major complications. Mean estimated blood loss (EBL) was 247 mL and mean total operative time was 496 minutes. The mean number of lymph nodes harvested was 24.6, with 30.5 for extended dissection. EBL (over 300 mL), operative time, and method of urinary diversion were significant negative predictors of minor complications, whereas EBL (over 300 mL) was a significant negative predictor of major complications (p<0.05).
CONCLUSIONS
The present results show that the complication rate reported by use of a standardized methodology after robotic radical cystectomy is still considerable although comparable to that of contemporary robot series. EBL, operative time, and diversion methods were predictors of complications.

Keyword

Cystectomy; Postoperative complication; Robotics; Urinary diversion

MeSH Terms

Adult
Aged
Anastomotic Leak
Blood Loss, Surgical
Cystectomy/*adverse effects
Female
Hospitals, University
Humans
Logistic Models
Lymph Node Excision
Male
Middle Aged
Operative Time
*Postoperative Complications
Prospective Studies
Republic of Korea
Risk Factors
*Robotic Surgical Procedures
Surgical Wound Dehiscence
Thromboembolism
Treatment Outcome
Urinary Bladder/pathology
Urinary Bladder Neoplasms/*surgery
Urinary Diversion/*adverse effects

Reference

1. Stein JP, Lieskovsky G, Cote R, Groshen S, Feng AC, Boyd S, et al. Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol. 2001; 19:666–675.

2. Yuh BE, Nazmy M, Ruel NH, Jankowski JT, Menchaca AR, Torrey RR, et al. Standardized analysis of frequency and severity of complications after robot-assisted radical cystectomy. Eur Urol. 2012; 62:806–813.

3. Sung HH, Ahn JS, Seo SI, Jeon SS, Choi HY, Lee HM, et al. A comparison of early complications between open and robot-assisted radical cystectomy. J Endourol. 2012; 26:670–675.

4. Hemal AK. Role of robot-assisted surgery for bladder cancer. Curr Opin Urol. 2009; 19:69–75.

5. Woods ME, Wiklund P, Castle EP. Robot-assisted radical cystectomy: recent advances and review of the literature. Curr Opin Urol. 2010; 20:125–129.

6. Kang SG, Kang SH, Lee YG, Rha KH, Jeong BC, Ko YH, et al. Robot-assisted radical cystectomy and pelvic lymph node dissection: a multi-institutional study from Korea. J Endourol. 2010; 24:1435–1440.

7. Kang SC, Kang SG, Choi H, Ko YH, Lee JG, Kim JJ, et al. The feasibility of robot-assisted laparoscopic radical cystectomy with pelvic lymphadenectomy: from the viewpoint of extended pelvic lymphadenectomy. Korean J Urol. 2009; 50:870–878.

8. Kang SG, Ko YH, Jang HA, Kim J, Kim SH, Cheon J, et al. Initial experience of robot-assisted radical cystectomy with total intracorporeal urinary diversion: comparison with extracorporeal method. J Laparoendosc Adv Surg Tech A. 2012; 22:456–462.

9. Donat SM. Standards for surgical complication reporting in urologic oncology: time for a change. Urology. 2007; 69:221–225.

10. Shabsigh A, Korets R, Vora KC, Brooks CM, Cronin AM, Savage C, et al. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol. 2009; 55:164–174.

11. Hayn MH, Hellenthal NJ, Hussain A, Stegemann AP, Guru KA. Defining morbidity of robot-assisted radical cystectomy using a standardized reporting methodology. Eur Urol. 2011; 59:213–218.

12. Khan MS, Elhage O, Challacombe B, Rimington P, Murphy D, Dasgupta P. Analysis of early complications of robotic-assisted radical cystectomy using a standardized reporting system. Urology. 2011; 77:357–362.

13. Pruthi RS, Nielsen ME, Nix J, Smith A, Schultz H, Wallen EM. Robotic radical cystectomy for bladder cancer: surgical and pathological outcomes in 100 consecutive cases. J Urol. 2010; 183:510–514.

14. Ng CK, Kauffman EC, Lee MM, Otto BJ, Portnoff A, Ehrlich JR, et al. A comparison of postoperative complications in open versus robotic cystectomy. Eur Urol. 2010; 57:274–281.

15. Lowrance WT, Rumohr JA, Chang SS, Clark PE, Smith JA Jr, Cookson MS. Contemporary open radical cystectomy: analysis of perioperative outcomes. J Urol. 2008; 179:1313–1318.

16. Pruthi RS, Nix J, McRackan D, Hickerson A, Nielsen ME, Raynor M, et al. Robotic-assisted laparoscopic intracorporeal urinary diversion. Eur Urol. 2010; 57:1013–1021.

17. Guru K, Seixas-Mikelus SA, Hussain A, Blumenfeld AJ, Nyquist J, Chandrasekhar R, et al. Robot-assisted intracorporeal ileal conduit: Marionette technique and initial experience at Roswell Park Cancer Institute. Urology. 2010; 76:866–871.

18. Ahmed K, Khan SA, Hayn MH, Agarwal PK, Badani KK, Balbay MD, et al. Analysis of intracorporeal compared with extracorporeal urinary diversion after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol. 2014; 65:340–347.