Robotic-assisted radical cystectomy with cutaneous ureterostomies: a contemporary multicenter analysis

Reuben Ben-David, Francesco Pellegrino, Parissa Alerasool, Neeraja Tillu, Etienne Lavallee, Kyrollis Attalla, Nikhil Waingankar, Sfakianos P. John, Reza Mehrazin, Marco Moschini, Alberto Martini, Sebastian Edeling, Alberto Briganti, Francesco Montorsi, Peter Wiklund

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Robotic-assisted radical cystectomy (RARC) offers decreased blood loss during surgery, shorter hospital length of stay, and lower risk for thromboembolic events without hindering oncological outcomes. Cutaneous ureterostomies (UCS) are a seldom utilized diversion that can be a suitable alternative for a selected group of patients with competing co-morbidities and limited life expectancy. Objective: To describe operative and perioperative characteristics as well as oncological outcomes for patients that underwent RARC + UCS. Methods: Patients that underwent RARC + UCS during 2013–2023 in 3 centers (EU = 2, US = 1) were identified in a prospectively maintained database. Baseline characteristics, pathological, and oncological outcomes were analyzed. Descriptive statistics and survival analysis were performed using R language version 4.3.1. Results: Sixty-nine patients were included. The median age was 77 years (IQR 70–80) and the median follow-up time was 11 months (IQR 4–20). Ten patients were ASA 4 (14.5%). Nine patients underwent palliative cystectomy (13%). The median operation time was 241 min (IQR 202–290), and the median hospital stay was 8 days (IQR 6–11). The 30-day complication rate was 55.1% (grade ≥ 3a was 14.4%), and the 30-day readmission rate was 17.4%. Eleven patients developed metastatic recurrence (15.9%), and 14 patients (20.2%) died during the follow-up period. Overall survival at 6, 12, and 24 months was 84%, 81%, and 73%, respectively. Conclusions: RARC + UCS may offer lower complication and readmission rates without the need to perform enteric anastomosis, it can be considered in a selected group of patients with competing co-morbidities, or limited life expectancy. Larger prospective studies are necessary to validate these results.

Original languageEnglish
Article number251
JournalWorld Journal of Urology
Volume42
Issue number1
DOIs
StatePublished - Dec 2024

Keywords

  • Radical cystectomy
  • Ureterostomy
  • Urinary bladder neoplasms
  • Urinary diversion

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