Investig Clin Urol.  2019 Nov;60(6):463-471. 10.4111/icu.2019.60.6.463.

Oncological and functional outcomes of robot-assisted radical cystectomy in bladder cancer patients in a single tertiary center: Can these be preserved throughout the learning curve?

• Tae JH
• Pyun JH
• Shim JS
• Cho S
• Kang SG
• Ko YH
• Cheon J
• Lee JG
• Kang SH

• KMID: 2461058
• DOI: http://doi.org/10.4111/icu.2019.60.6.463

Abstract

PURPOSE
To evaluate the overall and segmental oncological and functional outcome of robot-assisted radical cystectomy (RARC) during the learning curve.
MATERIALS AND METHODS
From August 2007 to November 2017, a total of 120 bladder cancer patients were treated with RARC in a single-tertiary hospital. These were divided into three groups of 40 consecutive cases. Overall and subgroup analysis of each group was used to evaluate oncological and functional outcomes throughout the learning curve.
RESULTS
Among the 120 RARC cases, 42, 73, and 5 patients received extracorporeal urinary diversion (ECUD), intracorporeal urinary diversion (ICUD), and ureterocutaneostomy, respectively. There was a transition from ECUD to ICUD during the learning curve. The positive surgical margin rate was 0.8%. The mean lymph node yield for the standard and extended pelvic lymph node dissection was 12.5 and 30.1, respectively, and increased to 19.8 and 31.2 and further to 20.0 and 37.9, respectively, with each additional series of 40 cases. The 5-year overall survival and 3-year recurrence-free survival rates were 86.6% and 81.4%, respectively. The 1-year daytime continence rate was 75.7%, while the nighttime continence rate was 51.4%. The potency preservation rate was 66.7% (n=8) with or without phosphodiesterase-5 inhibitors (PDE5-I) at 1 year and 33.3% without PDE5-I (n=4).
CONCLUSIONS
RARC results in comparable oncological and functional outcomes to open radical cystectomy. In addition, the oncological and functional outcomes were well maintained throughout the learning curve. ECUD transition to ICUD was safe and did not compromise oncological or functional outcome.

Keyword

Cystectomy; Robotics; Urinary bladder neoplasms

MeSH Terms

Cyclic Nucleotide Phosphodiesterases, Type 5
Cystectomy*
Humans
Learning Curve*
Learning*
Lymph Node Excision
Lymph Nodes
Robotics
Survival Rate
Urinary Bladder Neoplasms*
Urinary Bladder*
Urinary Diversion
Cyclic Nucleotide Phosphodiesterases, Type 5

Figure

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  Fig. 1 Extended pelvic lymphadenectomy. (A) Triangle of Marcille. (B) Deep obturator. (C) Aortic bifurcation. (D) Left side final aspect.

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  Fig. 2 Neurovascular bundle preservation. (A) Intrafascial dissection of the neurovascular bundle from the lateral prostatic surface, left side. (B) The final aspect.

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  Fig. 3 Female robot-assisted radical cystectomy. (A) Round ligament suspension. (B) Reproductive organ-sparing radical cystectomy. (C) The final aspect. RL, round ligament; FT, fallopian tube; UC, urethral catheter.

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