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A Proposal for Standardization of Early Outcomes Following Robot-Assisted Radical Cystectomy (RARC): RARC Tetrafecta

  • Urologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Currently, there is no dedicated tool to record the early outcomes of robot-assisted radical cystectomy (RARC), and existing criteria for longer-term outcomes require a minimum of 3 months for assessment. However, early evaluation is essential to prevent future morbidity and mortality, especially in surgeries with a high risk of complications in the short term. We propose a comprehensive approach to report early RARC outcomes and investigate the influence of surgeon experience on these results.

Patients and Methods

We retrospectively analyzed the outcomes of patients who underwent RARC for bladder cancer between April 2009 and April 2020. The cohort was divided chronologically into three groups: patients 1–60 in group 1, 61–120 in group 2, and 121–192 in group 3. Patients with yields of ≥ 16 lymph nodes (LN), negative soft tissue surgical margins, absence of transfusion, and absence of major complications at 30 days were regarded as attaining the RARC tetrafecta.

Results

Of the 192 included patients, 93 (48.4%) achieved RARC tetrafecta, with the proportion increasing with surgical experience from 41.7% in group 1 to 55.6% in group 3. Age [odds ratio (OR) 0.947; 95% confidence interval (CI) 0.924–0.970; P = 0.021], LN yield (OR 1.432; 95% CI 1.139–1.867; P = 0.001), and greater surgical experience with RARC (> 120 patients; OR 2.740; 95% CI 1.231–6.100; P = 0.014) were significantly associated with the achievement of RARC tetrafecta.

Conclusions

RARC tetrafecta could be a comprehensive method for reporting early outcomes in patients undergoing RARC, with improvements aligned with the surgeon’s experience.

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Funding

There are no conflicts of interest, financial affiliations, or material support from any author regarding the subject of this study. The authors report no involvement in the research by the sponsor, which could have influenced the outcome of this study.

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Author notes

  1. Wan Song and Jiwoong Yu have contributed equally to this work and should be considered co-first authors.

Authors and Affiliations

  1. Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

    Wan Song MD, PhD, Jiwoong Yu MD, Minyong Kang MD, PhD, Hyun Hwan Sung MD, PhD, Hwang Gyun Jeon MD, PhD, Seong Il Seo MD, PhD, Seong Soo Jeon MD, PhD & Byong Chang Jeong MD, PhD

  2. Department of Urology, Hallym University College of Medicine, Anyang, Korea

    Jae Hoon Chung MD, PhD

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  1. Wan Song MD, PhD
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Correspondence to Byong Chang Jeong MD, PhD.

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Song, W., Yu, J., Chung, J.H. et al. A Proposal for Standardization of Early Outcomes Following Robot-Assisted Radical Cystectomy (RARC): RARC Tetrafecta. Ann Surg Oncol (2024). https://doi.org/10.1245/s10434-024-15138-7

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