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Minerva Urologica e Nefrologica 2020 Oct 05

DOI: 10.23736/S0393-2249.20.03948-X

Copyright © 2020 EDIZIONI MINERVA MEDICA

language: English

Robot-assisted radical cystectomy with intracorporeal neobladder: impact of learning curve and long-term assessment of functional outcomes

Gabriele TUDERTI 1 , Riccardo MASTROIANNI 1, 2, Aldo BRASSETTI 1, Alfredo M. BOVE 1, Leonardo MISURACA 1, Umberto ANCESCHI 1, Mariaconsiglia FERRIERO 1, Michele GALLUCCI 2, Giuseppe SIMONE 1

1 Department of Urology, “Regina Elena” National Cancer Institute, Rome, Italy; 2 Department of Urology, Sapienza University, Rome, Italy


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BACKGROUND: There is paucity of data about functional outcomes of Robot-assisted Radical Cystectomy (RARC) with intracorporeal orhotopic neobladder (ICON), and the impact of learning curve (LC) on those outcomes remains to be addressed. We aimed to report long-term functional outcomes of our single center series of RARC with ICON, assessing the role of LC in their achievement.
METHODS: Patients treated with Robot assisted radical cystectomy with intracorporeal orthotopic neobladder in our center between January 2012 an August 2019 were retrospectively analysed. Preoperative, clinical, perioperative, pathologic and functional data were reported. The first cases were divided in tertiles, for assessing the impact of learning curve on the outcomes evaluated. Long-term functional outcomes of the whole cohort were evaluated.
RESULTS: Overall, 167 patients were included. Concerning tertiles analysis, operative time (p<0.001), incidence of low (p=0.002) and high grade (p=0.001) complications and hospital stay (p=0.04) decreased significantly over time. Day-time continence recovery probability was significantly lower in the initial case series (1-yr rate 68.4%, 87% and 89.8 for I, II and III tertile, respectively; p=0.04;). Accordingly, Trifecta achievement was significantly higher in II and III tertiles (p=0.01). At a median follow- up of 34 months, the incidence of significant renal function deterioration of the whole cohort was 16.7%. Overall, 12, 24 and 60-mo day-time continence rates were 74.8 %, 82.7 % and 82.7 %.
CONCLUSIONS: Patients treated at the beginning of the learning curve show worse perioperative and functional results. Once standardized the procedure, complications rates, hospital stay and daytime continence recovery experienced a significant improvement. At a long-term analysis of functional outcomes of our patients, renal function preservation and continence recovery results are encouraging.


KEY WORDS: Functional outcomes; Intracorporeal neobladder; Learning curve; Robotic cystectomy; Urinary continence

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