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Peri-operative, Functional, Quality of Life, and Oncological Outcomes After Robot-Assisted Radical Cystectomy and Intra-corporeal Orthotopic Ileal Neobladder—Our Experience

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Indian Journal of Surgical Oncology Aims and scope Submit manuscript

Abstract

Robot-assisted radical cystectomy (RARC) and intracorporeal orthotopic neobladder (OINB) is technically a challenging surgery due to the involvement of prolonged console time and higher level of surgical skills. Therefore, standardizing technique and testament of good functional and oncological outcomes is required to increase its acceptance among surgeons. We report our experience of RARC with OINB and analyze the perioperative, functional, quality of life, and survival outcomes. Single surgeon experience of over 22 OINB after RARC is done, which includes 21 male and one female patients, was done retrospectively. Modified Karolinska Studer technique of neobladder creation was followed. Intraoperative findings, post-operative complications, and follow-up information were recorded for analysis. The patients’ median age was 50.5 years (IQR, 41.25–55.50), and the median follow-up period was 45.5 months (IQR, 26.75–68). Median console time was 447.5 min (IQR, 347.5–500), blood loss was 225 ml (IQR, 200–250), and hospital stay was 12 days (IQR, 11–15). Most of the complications were Clavien-Dindo grades I and II. Longer surgery time and more complications were noted in the first 10 cases compared to the next 12 cases. Day and night-time urinary continence is 95% and 77% at 12 months, respectively. Two patients died of disease, and overall survival at 5 years was 84%. Our experience supports OINB as a feasible option after RCIC with acceptable complications, good functional and survival outcomes, with better quality of life. With experience, surgical morbidity and operative time decrease. This surgery should be undertaken after gaining experience with an intracorporeal ileal conduit and has a steep learning curve.

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References

  1. Alfred Witjes J, Lebret T, Compérat EM, Cowan NC, De Santis M, Bruins HM et al (2017) Updated 2016 EAU guidelines on muscle-invasive and metastatic bladder cancer. Eur Urol 71(3):462–475

    Article  CAS  Google Scholar 

  2. Hara I, Miyake H, Hara S, Gotoh A, Nakamura I, Okada H et al (2002) Health-related quality of life after radical cystectomy for bladder cancer: a comparison of ileal conduit and orthotopic bladder replacement. BJU Int 89(1):10–13

    Article  CAS  Google Scholar 

  3. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 68(6):394–424

    Article  Google Scholar 

  4. Tan WS, Kelly JD. Is experience with extracorporeal urinary diversion following robotic assisted radical cystectomy necessary before transitioning to intracorporeal urinary diversion? Vol. 7, Translational Andrology and Urology. AME Publishing Company; 2018. p. S735–7.

  5. Camey M, Duc A. Enterocystoplasty after total cystoprostatectomy for invasive bladder cancer. Experience from eighty-seven cases[l’entero-cystoplastie apres cysto-prostatectomie totale pour cancer de vessie. Indications, technique operatoire, surveillance et resultats sur quatre-vingt-sept cas]. Ann Urol. 1979;13:114–123.

  6. Ukimura O, Moinzadeh A, Gill IS. Laparoscopic radical cystectomy and urinary diversion. Vol. 6, Current urology reports. Springer; 2005. p. 118–21.

  7. Gill IS, Fergany A, Klein EA, Kaouk JH, Sung GT, Meraney AM et al (2000) Laparoscopic radical cystoprostatectomy with ileal conduit performed completely intracorporeally: The initial 2 cases. Urology 56(1):26–29

    Article  CAS  Google Scholar 

  8. Menon M, Hemal AK, Tewari A, Shrivastava A, Shoma AM, El-Tabey NA et al (2003) Nerve-sparing robot-assisted radical cystoprostatectomy and urinary diversion. BJU Int 92(3):232–236

    Article  CAS  Google Scholar 

  9. Beecken W-D, Wolfram M, Engl T, Bentas W, Probst M, Blaheta R et al (2003) Robotic-assisted laparoscopic radical cystectomy and intra-abdominal formation of an orthotopic ileal neobladder. Eur Urol 44(3):337–339

    Article  Google Scholar 

  10. Haber G-P, Gill IS (2007) Laparoscopic radical cystectomy for cancer: oncological outcomes at up to 5 years. BJU Int 100(1):137–142

    Article  Google Scholar 

  11. Qu LG, Lawrentschuk N. Orthotopic neobladder reconstruction: patient selection and perspectives. Res Rep Urol [Internet]. 2019 Dec 11 [cited 2020 Jun 25];11:333–41. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6912000/

  12. Hussein Ahmed A., May Paul R., Jing Zhe, Ahmed Youssef E., Wijburg Carl J., Canda Abdulla Erdem, et al. Outcomes of intracorporeal urinary diversion after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. J Urol [Internet]. 2018 May 1 [cited 2020 Jun 25];199(5):1302–11. Available from: https://www.auajournals.org/doi/https://doi.org/10.1016/j.juro.2017.12.045

  13. Benamran D, Phé V, Drouin SJ, Perrot O, Grégoris A, Parra J, et al. Functional outcomes obtained with intracorporeal neobladder after robotic radical cystectomy for cancer: a narrative review. J Robot Surg. 2020;

  14. Desai MM, Gill IS, de Castro Abreu AL, Hosseini A, Nyberg T, Adding C et al (2014) Robotic intracorporeal orthotopic neobladder during radical cystectomy in 132 patients. J Urol 192(6):1734–1740

    Article  Google Scholar 

  15. Goh AC, Gill IS, Lee DJ, de Castro Abreu AL, Fairey AS, Leslie S et al (2012) Robotic intracorporeal orthotopic ileal neobladder: replicating open surgical principles. Eur Urol 62(5):891–901

    Article  Google Scholar 

  16. Jonsson MN, Adding LC, Hosseini A, Schumacher MC, Volz D, Nilsson A et al (2011) Robot-assisted radical cystectomy with intracorporeal urinary diversion in patients with transitional cell carcinoma of the bladder. Eur Urol 60(5):1066–1073

    Article  Google Scholar 

  17. Schumacher MC, Jonsson MN, Hosseini A, Nyberg T, Poulakis V, Pardalidis NP et al (2011) Surgery-related complications of robot-assisted radical cystectomy with intracorporeal urinary diversion. Urology 77(4):871–876

    Article  Google Scholar 

  18. Ginsberg D, Huffman JL, Lieskovsky G, Boyd S, Skinner DG (1991) Urinary tract stones: a complication of the Kock pouch continent urinary diversion. J Urol 145(5):956–959

    Article  CAS  Google Scholar 

  19. Tyritzis SI, Hosseini A, Collins J, Nyberg T, Jonsson MN, Laurin O et al (2013) Oncologic, functional, and complications outcomes of robot-assisted radical cystectomy with totally intracorporeal neobladder diversion. Eur Urol 64(5):734–741

    Article  Google Scholar 

  20. Fontana D, Bellina M, Fasolis G, Frea B, Scarpa RM, Mari M et al (2004) Y-neobladder: an easy, fast, and reliable procedure. Urology 63(4):699–703

    Article  CAS  Google Scholar 

  21. Ferriero M, Guaglianone S, Papalia R, Muto GL, Gallucci M, Simone G (2015) Risk assessment of stone formation in stapled orthotopic ileal neobladder. J Urol 193(3):891–896

    Article  Google Scholar 

  22. Mills RD, Studer UE (1999) Metabolic consequences of continent urinary diversion. J Urol 161(4):1057–1066

    Article  CAS  Google Scholar 

  23. Simone G, Papalia R, Misuraca L, Tuderti G, Minisola F, Ferriero M et al (2018) Robotic intracorporeal padua ileal bladder: surgical technique, perioperative, oncologic and functional outcomes. Eur Urol 73(6):934–940

    Article  Google Scholar 

  24. Perlis N, Krahn MD, Boehme KE, Alibhai SMH, Jamal M, Finelli A et al (2018) The bladder utility symptom scale: a novel patient reported outcome instrument for bladder cancer. J Urol 200(2):283–291

    Article  Google Scholar 

  25. Parekh DJ, Reis IM, Castle EP, Gonzalgo ML, Woods ME, Svatek RS, et al. Robot-assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer (RAZOR): an open-label, randomised, phase 3, non-inferiority trial. The Lancet [Internet]. 2018 Jun 23 [cited 2020 Jun 25];391(10139):2525–36. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)30996-6/abstract

  26. Raza SJ, Wilson T, Peabody JO, Wiklund P, Scherr DS, Al-Daghmin A et al (2015) Long-term oncologic outcomes following robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol 68(4):721–728

    Article  Google Scholar 

Download references

Acknowledgements

The authors thank Dr. Meenal Hastak and Dr. Bijal Kulkarni for their continued support and discussion of pathological aspects of disease, Dr. Neha Sanwalka for her immense help in statistical analysis, and Dr. Ashwini Preetham for the illustrations.

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Authors and Affiliations

  1. Department of Uro-Oncology, Kokilaben Dhirubhai Ambani Hospital & Research Institute, Rao Saheb, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, India

    T. B. Yuvaraja, Santosh S. Waigankar, Preetham Dev, Varun Agarwal & Abhinav P. Pednekar

  2. Department of Pathology, Kokilaben Dhirubhai Ambani Hospital & Research Institute, Rao Saheb, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, India

    Nevitha Athikari

  3. Department of Radiology, Kokilaben Dhirubhai Ambani Hospital & Research Institute, Rao Saheb, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, India

    Abhijit Raut & Diptiman Roy

  4. Department of Nuclear Medicine, Kokilaben Dhirubhai Ambani Hospital & Research Institute, Rao Saheb, Achutrao Patwardhan Marg, Four Bungalows, Andheri West, Mumbai, India

    Hemant Khandare

Authors
  1. T. B. Yuvaraja
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  2. Santosh S. Waigankar
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Correspondence to T. B. Yuvaraja.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed written consent for surgery was taken, but consent to be involved in study was not, as it was a retrospective study.

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Yuvaraja, T.B., Waigankar, S.S., Dev, P. et al. Peri-operative, Functional, Quality of Life, and Oncological Outcomes After Robot-Assisted Radical Cystectomy and Intra-corporeal Orthotopic Ileal Neobladder—Our Experience. Indian J Surg Oncol 13, 716–722 (2022). https://doi.org/10.1007/s13193-022-01540-8

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  • DOI: https://doi.org/10.1007/s13193-022-01540-8

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