Robotic-assisted radical cystectomy: the first multicentric Brazilian experience
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ORIGINAL ARTICLE
Robotic‑assisted radical cystectomy: the first multicentric Brazilian experience Marcio Covas Moschovas1,3 · Daher Cesar Chade2 · Marco Antonio Arap3 · Alvaro Sadek Sarkis2 · William Carlos Nahas2 · Luiz Henrique Rodrigues Tanure1,5 · Gustavo Ebaid4 · Arnaldo Jose de Carvalho Fazoli2 · Giuliano Betoni Guglielmetti2 · Carolina Bistacco6 · Maurício Cordeiro2 · Paulo Afonso2 · Maria Chiara Sighinolfi7 · Bernardo Rocco7 · Rafael Ferreira Coelho2 Received: 6 November 2019 / Accepted: 6 January 2020 © Springer-Verlag London Ltd., part of Springer Nature 2020
Abstract The objective of this study is to report the first multicentric Brazilian series and learning curve of robotic radical cystectomy (RARC) with related intra- and postoperative outcomes. We retrospectively analyzed 37 RARC prospectively collected at four different centers in Brazil, from 2013 to 2019. We analyzed the patient’s demographics, pathological tumor, and nodal status, as well as intra- and postoperative outcomes. Statistical analysis was performed with the IBM (SPSS version 25) software. Overall, 86% were male, and the median age was 69 years. 83% had muscle-invasive bladder cancer, and 17% a high-grade, recurrent non-muscle-invasive tumor. The median operative time was 420 min with 300 min as console time. Median blood loss was 350 ml and transfusion rate was 10%. In 68% of the cases, we performed an intracorporeal Bricker urinary diversion, 24% intracorporeal neobladder, and 8% ureterostomy. Six patients (16%) had a Clavien 1–2, 8% had Clavien 3, 2.5% had a Clavien 4, and 5% had Clavien 5. The median length of hospital stay was 7 days. The final pathological exam pointed out pT0 in 16%, pT1 in 8%, pT2 in 32%, ≥ pT3 in 27%, and 16% pTis. 95% had negative surgical margins. The survival at 30, 90, and 180 days was 98%, 95%, and 95%, respectively. To our knowledge, this is the first multicentric series of RARC reporting the learning curve in Brazil; even if still representing a challenging procedure, RARC could be safely and effectively faced by experienced surgeons at centers with high volumes of robotic surgery. Keywords Robotic surgery · Robotic-assisted radical cystectomy · Bladder cancer
Introduction Radical cystectomy (RC) represents the standard of care for very-high-risk non-muscle-invasive BCa and non-metastatic, muscle-invasive BCa [1].
* Marcio Covas Moschovas [email protected] 1
Hospital 9 de Julho, São Paulo, Brazil
2
Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
3
Hospital Sírio Libanês, São Paulo, Brazil
4
Hospital das Clínicas, São Paulo, Brazil
5
Hospital Paulistano, São Paulo, Brazil
6
Faculdade de Medicina do ABC, São Paulo, Brazil
7
University of Modena and Reggio Emilia, Modena, Italy
Indeed, RC is one of the most challenging surgical procedures, based on a demolition phase, an extended nodal dissection, and, finally, a reconstructive step to restore the urinary tract. Given such complexity and despite consolidated surgical techniques, radical cystectomy is
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