OBJECTIVES:To explore the effects of ischaemia time (IT) in a multicentre cohort of patients with solitary kidney (SK), treated with partial nephrectomy (PN) for a renal mass, on short- and long-term kidney function, haemorrhagic risk and pathological outcomes. METHODS:This is an observational study of 426 patients with SK treated with on- and off-clamp PN for a single cT1-3 N0M0 renal mass from 2000 to 2023 at 19 global institutions. The primary outcomes were postoperative and 1-year renal function. The secondary outcomes of the study were haemorrhagic risk, defined as estimated blood loss (EBL) and peri-operative transfusions, and presence of positive surgical margins. The effect of IT and arterial clamping strategy was estimated using linear and logistic regressions for continuous and categorical outcomes, respectively. RESULTS:On-clamp PN was performed in 56% of patients (n = 237). The median (interquartile range [IQR]) age, body mass index, preoperative estimated glomerular filtration rate (eGFR), clinical size and PADUA score were 65 (58-71) years, 27 (24-29) kg/m2, 58 (45-46) mL/min, 3 (2-4.2) cm and 8 (7-10), respectively. The median (IQR) duration of IT was 19 (13-25) min. In multivariable linear and logistic regression analyses (MVA), IT was not associated with decreased postoperative eGFR (estimate -0.08 mL/min; P = 0.3) or 1-year eGFR (estimate -0.1 mL/min; P = 0.2). No association between on-clamp strategy and eGFR decline was recorded either postoperatively (estimate -3.11 mL/min; P = 0.1) or at 1 year (estimate -3.12 mL/min; P = 0.1). The median (IQR) EBL was lower in the on-clamp group at 200 (100-400) mL vs 300 (145-500) mL in the off-clamp group. In MVA predicting haemorrhagic risk, arterial clamping was associated with lower risk of transfusions (odds ratio 0.45; P = 0.01). CONCLUSIONS:In patients with SK, on-clamp PN did not affect long-term renal function and was associated with a modestly lower need for peri-operative transfusion. The routine use of the off-clamp technique is therefore not supported by these findings, although its selective application may remain appropriate in cases with a high risk of renal function decline.

Objectives The use of digital technology in surgery is increasing rapidly, with a wide array of new applications from presurgical planning to postsurgical performance assessment. Understanding the clinical and economic value of these technologies is vital for making appropriate health policy and purchasing decisions. We explore the potential value of digital technologies in surgery and produce expert consensus on how to assess this value.Design A modified Delphi and consensus conference approach was adopted. Delphi rounds were used to generate priority topics and consensus statements for discussion.Setting and participants An international panel of 14 experts was assembled, representing relevant stakeholder groups: clinicians, health economists, health technology assessment experts, policy-makers and industry.Primary and secondary outcome measures A scoping questionnaire was used to generate research questions to be answered. A second questionnaire was used to rate the importance of these research questions. A final questionnaire was used to generate statements for discussion during three consensus conferences. After discussion, the panel voted on their level of agreement from 1 to 9; where 1=strongly disagree and 9=strongly agree. Consensus was defined as a mean level of agreement of >7.Results Four priority topics were identified: (1) how data are used in digital surgery, (2) the existing evidence base for digital surgical technologies, (3) how digital technologies may assist surgical training and education and (4) methods for the assessment of these technologies. Seven consensus statements were generated and refined, with the final level of consensus ranging from 7.1 to 8.6.Conclusion Potential benefits of digital technologies in surgery include reducing unwarranted variation in surgical practice, increasing access to surgery and reducing health inequalities. Assessments to consider the value of the entire surgical ecosystem holistically are critical, especially as many digital technologies are likely to interact simultaneously in the operating theatre.

OBJECTIVE:To assess the role of neoadjuvant chemotherapy (NAC) before robot-assisted radical cystectomy (RARC) for patients with variant histology (VH) muscle-invasive bladder cancer (MIBC). METHODS:Retrospective review of 988 patients who underwent RARC (2004-2023) for MIBC. Primary outcomes included the utilization of NAC among this cohort of patients, frequency of downstaging, and discordance between preoperative and final pathology in terms of the presence of VH. Secondary outcomes included disease-specific (DSS), recurrence-free (RFS), and overall survival (OS). RESULTS:A total of 349 (35%) had VH on transurethral resection or at RARC. The 4 most common VH subgroups were squamous (n = 94), adenocarcinoma (n = 64), micropapillary (n = 34), and sarcomatoid (n = 21). There was no difference in OS (log-rank: P = 0.43 for adenocarcinoma, P = 0.12 for micropapillary, P = 0.55 for sarcomatoid, P = 0.29 for squamous), RFS (log-rank: P = 0.25 for adenocarcinoma, P = 0.35 for micropapillary, P = 0.83 for sarcomatoid, P = 0.79 for squamous), or DSS (log-rank P = 0.91 for adenocarcinoma, P = 0.15 for micropapillary, 0.28 for sarcomatoid, P = 0.92 for squamous) among any of the VH based on receipt of NAC. Patients with squamous histology who received NAC were more likely to be downstaged on final pathology compared to those who did not (P < 0.01). CONCLUSION:Our data showed no significant difference in OS, RFS, or DSS for patients with VH MIBC cancer who received NAC before RARC. Patients with the squamous variant who received NAC had more pathologic downstaging compared to those who did not. The role of NAC among patients with VH is yet to be defined. Results were limited by small number in each individual group and lack of exact proportion of VH.

Abstract To investigate the influence of preoperative smoking history on the survival outcomes and complications in a cohort from a large multicenter database. Many patients who undergo radical cystectomy (RC) have a history of smoking; however, the direct association between preoperative smoking history and survival outcomes and complications in patients with muscle-invasive bladder cancer (MIBC) who undergo robot-assisted radical cystectomy (RARC) remains unexplored. We conducted a retrospective analysis using data from 749 patients in the Korean Robot-Assisted Radical Cystectomy Study Group (KORARC) database, with an average follow-up duration of 30.8 months. The cohort was divided into two groups: smokers (n = 351) and non-smokers (n = 398). Propensity score matching was employed to address differences in sample size and baseline demographics between the two groups (n = 274, each). Comparative analyses included assessments of oncological outcomes and complications. After matching, smoking did not significantly affect the overall complication rate (p = 0.121). Preoperative smoking did not significantly increase the occurrence of complications based on complication type (p = 0.322), nor did it increase the readmission rate (p = 0.076). There were no perioperative death in either group. Furthermore, preoperative smoking history showed no significant impact on overall survival (OS) [hazard ratio (HR) = 0.87, interquartile range (IQR): 0.54–1.42; p = 0.589] and recurrence-free survival (RFS) (HR = 1.12, IQR: 0.83–1.53; p = 0.458) following RARC for MIBC. The extent of preoperative smoking (≤ 10, 10–30, and ≥ 30 pack-years) had no significant influence on OS and RFS in any of the categories (all p > 0.05). Preoperative smoking history did not significantly affect OS, RFS, or complications in patients with MIBC undergoing RARC.

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy V (MP67)1 May 2024MP67-07 RISKS AND BENEFITS OF PARTIAL NEPHRECTOMY WITH LIMITED OR WITHOUT ISCHEMIA TIME IN THE EXTREME SCENARIO OF PATIENTS WITH A SOLITARY KIDNEY Francesco Cei, Daniele Cignoli, Andrea Minervini, Andrea Mari, Fabrizio Di Maida, Karim Bensalah, Benoit Peyronnet, Riccardo Schiavina, Lorenzo Bianchi, Alexandre Mottrie, Geert De Naeyer, Ruben De Groote, Alessandro Antonelli, Riccardo Bertolo, Koon Ho Rha, Ahmad Almujalhem, Ithaar Derweesh, Aaron W. Bradshaw, Jihad Kaouk, Guilherme V. Sawczyn, Alberto Breda, Umberto Capitanio, Francesco Montorsi, and Alessandro Larcher Francesco CeiFrancesco Cei , Daniele CignoliDaniele Cignoli , Andrea MinerviniAndrea Minervini , Andrea MariAndrea Mari , Fabrizio Di MaidaFabrizio Di Maida , Karim BensalahKarim Bensalah , Benoit PeyronnetBenoit Peyronnet , Riccardo SchiavinaRiccardo Schiavina , Lorenzo BianchiLorenzo Bianchi , Alexandre MottrieAlexandre Mottrie , Geert De NaeyerGeert De Naeyer , Ruben De GrooteRuben De Groote , Alessandro AntonelliAlessandro Antonelli , Riccardo BertoloRiccardo Bertolo , Koon Ho RhaKoon Ho Rha , Ahmad AlmujalhemAhmad Almujalhem , Ithaar DerweeshIthaar Derweesh , Aaron W. BradshawAaron W. Bradshaw , Jihad KaoukJihad Kaouk , Guilherme V. SawczynGuilherme V. Sawczyn , Alberto BredaAlberto Breda , Umberto CapitanioUmberto Capitanio , Francesco MontorsiFrancesco Montorsi , and Alessandro LarcherAlessandro Larcher View All Author Informationhttps://doi.org/10.1097/01.JU.0001009496.54470.10.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Growing evidence suggests that ischemia time [IT] has far less influence on postoperative renal function compared to other factors. However, the information available on the trade-off for risk and benefit of IT on long-term renal function in case patients with solitary kidney [SK] elected for partial nephrectomy [PN] is scarce. Accordingly, the aim of the study is to evaluate the potential benefit and harms of no or limited IT during PN in patients with solitary kidney. METHODS: This study included 244 single-kidney patients treated with elective PN for a single cT1–2N0M0 renal mass at nine high-volume European, North American, and Asian institutions. IT was defined as the duration of clamping of the main renal artery. The primary outcome of the study was postoperative, 1-year and long-term renal function defined as estimated glomerular filtration rate [eGFR]. The secondary outcome of the study were estimated blood loss [EBL] and perioperative transfusions. We relied on linear, logistic and Cox regression analysis [MVA] accounting for age, comorbidities, clinical size, preoperative eGFR and year of surgery to assess the impact of IT on the study outcomes. RESULTS: Off-clamp PN was performed in 127 patients (52%). The median duration of IT for patients treated with on-clamp strategy was 18 minutes. At MVA predicting renal function, longer IT resulted associated with decreased postoperative eGFR (Est -0.37; p=0.03). Conversely, no association between IT and eGFR was recorded at 1 year (Est -0.04; p=0.7) or at long term follow-up (Est -0.28; p=0.07). At MVA predicting hemorrhagic risk, IT resulted associated with EBL (Est -6.16; p=0.04) and perioperative transfusion (OR 0.99; p=0.01; Figures 1A-1B). CONCLUSIONS: In SK patients, performing off-clamp PN is associated with improved renal function at short term assessment only and at long term follow-up, any advantage relative to on-clamp PN phases out. Conversely, off-clamp PN increases hemorrhagic risk. These findings support hilum preparation and on-clamp PN even in the extreme scenario of SK patients. Despite being the largest cohort of SK patients available to date, our conclusions may require further validation through larger sample sizes and even longer IT to confirm the hypothesis of a neutral impact of IT on renal function. Download PPT Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e1099 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Francesco Cei More articles by this author Daniele Cignoli More articles by this author Andrea Minervini More articles by this author Andrea Mari More articles by this author Fabrizio Di Maida More articles by this author Karim Bensalah More articles by this author Benoit Peyronnet More articles by this author Riccardo Schiavina More articles by this author Lorenzo Bianchi More articles by this author Alexandre Mottrie More articles by this author Geert De Naeyer More articles by this author Ruben De Groote More articles by this author Alessandro Antonelli More articles by this author Riccardo Bertolo More articles by this author Koon Ho Rha More articles by this author Ahmad Almujalhem More articles by this author Ithaar Derweesh More articles by this author Aaron W. Bradshaw More articles by this author Jihad Kaouk More articles by this author Guilherme V. Sawczyn More articles by this author Alberto Breda More articles by this author Umberto Capitanio More articles by this author Francesco Montorsi More articles by this author Alessandro Larcher More articles by this author Expand All Advertisement PDF downloadLoading ...

BACKGROUND:Health technology assessments (HTAs) of robotic assisted surgery (RAS) face several challenges in assessing the value of robotic surgical platforms. As a result of using different assessment methods, previous HTAs have reached different conclusions when evaluating RAS. While the number of available systems and surgical procedures is rapidly growing, existing frameworks for assessing MedTech provide a starting point, but specific considerations are needed for HTAs of RAS to ensure consistent results. This work aimed to discuss different approaches and produce guidance on evaluating RAS. METHODS:A consensus conference research methodology was adopted. A panel of 14 experts was assembled with international experience and representing relevant stakeholders: clinicians, health economists, HTA practitioners, policy makers, and industry. A review of previous HTAs was performed and seven key themes were extracted from the literature for consideration. Over five meetings, the panel discussed the key themes and formulated consensus statements. RESULTS:A total of ninety-eight previous HTAs were identified from twenty-five total countries. The seven key themes were evidence inclusion and exclusion, patient- and clinician-reported outcomes, the learning curve, allocation of costs, appropriate time horizons, economic analysis methods, and robotic ecosystem/wider benefits. CONCLUSIONS:Robotic surgical platforms are tools, not therapies. Their value varies according to context and should be considered across therapeutic areas and stakeholders. The principles set out in this paper should help HTA bodies at all levels to evaluate RAS. This work may serve as a case study for rapidly developing areas in MedTech that require particular consideration for HTAs.

Purpose: To accurately describe the three-dimensional topology of renal tumors, our study suggests a new nephrometry scoring system, the T-index, that combines information about intraparenchymal extension and peripherality of the renal tumor. Materials and Methods: This study included 113 patients who underwent partial nephrectomy for small clear cell renal cell carcinoma between 2007 and 2014. Manual segmentation of the renal parenchyma, sinus, and tumor was performed using preoperative computed tomography images. The T-index was calculated by adding the reciprocals of the distances from all points on the tumor-parenchyma interface to the renal sinus. Correlations with perioperative factors and the impact of the T-index on postoperative complications were evaluated and compared with existing nephrometry scoring systems (PADUA, RENAL, contact surface area [CSA], and C-index). Results: The mean value of the T-index among the 113 patients was 116.1±100.5 (1/mm). The T-index showed the strongest correlation with perioperative factors compared with other nephrometry scoring systems. The T-index was able to predict the risk for postoperative complications, either overall (p=0.015) or major complications (p=0.030). A predictive model based on the T-index of the overall postoperative complications presented the best performance (area under the curve, 0.692; 95% CI, 0.599–0.776) compared with other nephrometry scoring systems. Conclusions: The T-index can be considered as a single value comprising key structural indicators for surgical complexity. Our findings suggest that the T-index can provide a quantitative and objective scoring system associated with surgical difficulty and postoperative complications of partial nephrectomy.

You have accessJournal of UrologyCME1 Apr 2023PD09-06 15-YEAR OUTCOMES OF ROBOT-ASSISTED RADICAL CYSTECTOMY: RESULTS FROM THE INTERNATIONAL RADICAL CYSTECTOMY CONSORTIUM Usma Shabir, Jorge Daza, Grace Harrington, Mohammad Khan, Zuha Jaffar, Muhsinah Howlader, Claire Hannon, Zhe Jing, Jihad Kaouk, Bertram Yuh, James Peabody, Johar Raza Syed, Prokar Dasgupta, Mohammed Shamim Khan, Michael Stöckle, Eric Kim, Koon Rha, Peter Wiklund, Abolfazl Hosseini, Qiang Li, Ahmed A. Hussein, and Khurshid A. Guru Usma ShabirUsma Shabir More articles by this author , Jorge DazaJorge Daza More articles by this author , Grace HarringtonGrace Harrington More articles by this author , Mohammad KhanMohammad Khan More articles by this author , Zuha JaffarZuha Jaffar More articles by this author , Muhsinah HowladerMuhsinah Howlader More articles by this author , Claire HannonClaire Hannon More articles by this author , Zhe JingZhe Jing More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , Bertram YuhBertram Yuh More articles by this author , James PeabodyJames Peabody More articles by this author , Johar Raza SyedJohar Raza Syed More articles by this author , Prokar DasguptaProkar Dasgupta More articles by this author , Mohammed Shamim KhanMohammed Shamim Khan More articles by this author , Michael StöckleMichael Stöckle More articles by this author , Eric KimEric Kim More articles by this author , Koon RhaKoon Rha More articles by this author , Peter WiklundPeter Wiklund More articles by this author , Abolfazl HosseiniAbolfazl Hosseini More articles by this author , Qiang LiQiang Li More articles by this author , Ahmed A. HusseinAhmed A. Hussein More articles by this author , and Khurshid A. GuruKhurshid A. Guru More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003240.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We aimed to report the long-term follow-up of bladder cancer patients who underwent robot-assisted radical cystectomy (RARC) 15 years ago or more utilizing the International Radical Cystectomy Consortium (IRCC) database. METHODS: Patients who underwent RARC before 2007 were identified. Kaplan-Meier method was used to depict recurrence-free (RFS), disease-specific (DSS) and overall survival (OS). Multivariate COX regression model was used to identify the variables associated with RFS, DSS and OS. RESULTS: 271 patients were identified. Median follow-up time is 10 year (IQR 6-13) years. Twenty-five patients (10%) received neoadjuvant chemotherapy, 75 (28%) received neobladder, 117 (43%) had pT3/T4 and 63 (23%) had pN+ disease. RFS, DSS and OS were 60%, 63% and 30% at 15 years, respectively (Figure 1). Multivariate analysis showed that pT stage and pN+ remain the determinants of survival outcomes (Table 1). CONCLUSIONS: Locally advanced disease remains the main determinant of survival after RARC. Source of Funding: Vattikuti Foundation © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e241 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Usma Shabir More articles by this author Jorge Daza More articles by this author Grace Harrington More articles by this author Mohammad Khan More articles by this author Zuha Jaffar More articles by this author Muhsinah Howlader More articles by this author Claire Hannon More articles by this author Zhe Jing More articles by this author Jihad Kaouk More articles by this author Bertram Yuh More articles by this author James Peabody More articles by this author Johar Raza Syed More articles by this author Prokar Dasgupta More articles by this author Mohammed Shamim Khan More articles by this author Michael Stöckle More articles by this author Eric Kim More articles by this author Koon Rha More articles by this author Peter Wiklund More articles by this author Abolfazl Hosseini More articles by this author Qiang Li More articles by this author Ahmed A. Hussein More articles by this author Khurshid A. Guru More articles by this author Expand All Advertisement PDF downloadLoading ...

In a propensity-matched analysis of off- versus on-clamp robot-assisted partial nephrectomy, we reported no difference in functional outcomes. Off-clamp partial nephrectomy was associated with a significantly higher need for blood transfusion and conversion to radical nephrectomy.

In the original publication, affiliation p was listed as Department of Urology, Regina Elena National Cancer Institute, Rome, Italy. The authors would like it to be noted that the institution for this affiliation has IRCCS accreditation and the correct institution name is correctly listed above.

Background:Current literature does not provide large-scale data regarding clinical outcomes of robot-assisted (RAPN) versus open (OPN) partial nephrectomy. Moreover, data assessing predictors of long-term oncologic outcomes after RAPN are scarce. Objective:To compare perioperative, functional, and oncologic outcomes of RAPN versus OPN, and to investigate the predictors of oncologic outcomes after RAPN. Design setting and participants:This study included 3467 patients treated with OPN (n = 1063) or RAPN (n = 2404) for a single cT1-2N0M0 renal mass from 2004 to 2018 at nine high-volume European, North American, and Asian institutions. Outcome measurements and statistical analysis:The study outcomes were short-term postoperative, functional, and oncologic outcomes. Regression models investigated the effect of surgical approach (open vs Robot assisted) on study outcomes, and interaction tests were used for subgroup analyses. Propensity score matching for demographic and tumor characteristics was used in sensitivity analyses. Multivariable Cox-regression analyses identified predictors of oncologic outcomes after RAPN. Results and limitations:Baseline characteristics were similar between patients receiving RAPN and OPN, with only few differences. After adjusting for confounding, RAPN was associated with lower odds of intraoperative (odds ratio [OR]: 0.39, 95% confidence interval [CI]: 0.22, 0.68) and Clavien-Dindo ≥2 postoperative (OR: 0.29, 95% CI: 0.16, 0.50) complications (both p < 0.05). This association was not affected by comorbidities, tumor dimension, PADUA score, or preoperative renal function (all p > 0.05 on interaction tests). On multivariable analyses, we found no differences between the two techniques with respect to functional and oncologic outcomes (all p > 0.05). Overall, there were 63 and 92 local recurrences and systemic progressions, respectively, with a median follow-up after surgery of 32 mo (interquartile range: 18, 60). Among patients receiving RAPN, we assessed predictors of local recurrence and systemic progression with discrimination accuracy (ie, C-index) that ranged from 0.73 to 0.81. Conclusions:While cancer control and long-term renal function did not differ between RAPN and OPN, we found that the intra- and postoperative morbidity-especially in terms of complications-was lower after RAPN than after OPN. Our predictive models allow surgeons to estimate the risk of adverse oncologic outcomes after RAPN, with relevant implications for preoperative counseling and follow-up after surgery. Patient summary:In this comparative study on robotic versus open partial nephrectomy, functional and oncologic outcomes were similar between the two techniques, with lower morbidity-especially in terms of complications-for robot-assisted surgery. The assessment of prognosticators for patients receiving robot-assisted partial nephrectomy may help in preoperative counseling and provides relevant data to tailor postoperative follow-up.

Segmentation of the renal parenchyma responsible for a renal function is necessary for surgical planning and decisionmaking of renal partial nephrectomy (RPN) by identifying the correlation between the renal parenchyma volume and renal function after RPN on abdominal magnetic resonance (MR) images without radiation exposure. This paper proposes a cascaded self-adaptive framework that uses local context-aware mix-up regularization on abdominal MR images acquired from multiple devices. The proposed renal parenchyma segmentation network consists of two stages: kidney bounding volume extraction and renal parenchyma segmentation. Before kidney bounding volume extraction, self-adaptive normalization is performed using nnU-Net as the backbone network to reduce differences in signal intensity and pixel spacing among MR images of different intensity ranges acquired from multiple MR devices. In the kidney bounding volume extraction stage, the renal parenchyma area is segmented using 3D U-Net with low-resolution data down-sampled twice from the original to efficiently localize the kidney in the abdomen. Bounding volume is generated to focus on the renal parenchyma area during the renal parenchyma segmentation stage by cropping to the volume-of-interest region using the segmentation results up-sampled to the original resolution. In the segmentation stage, the renal parenchyma is segmented using 3D U-Net with mix-up augmented bounding volume to improve the regularization performance of the model. The average F1-score of our method was 92.27%, which was 3.07%p and 0.32%p higher than the segmentation method using original 3D cascaded nnU-Net and 3D cascaded nnU-Net with kidney bounding volume extraction, respectively.

Introduction: Oncologic implications of variant histology (VH) have been extensively studied in bladder cancer; however, further investigation is needed in upper tract urothelial carcinoma (UTUC). Our study aims to evaluate the impact of VH on oncological outcomes in UTUC patients treated with radical nephroureterectomy (RNU). Methods: A retrospective analysis was performed on patients who underwent a robotic or laparoscopic RNU for UTUC using the ROBUUST database, a multi-institutional collaborative including 17 centers worldwide. Logistic regression was used to assess the effect of VH on urothelial recurrence (bladder, contralateral upper tract), metastasis, and survival following RNU. Results: A total of 687 patients were included in this study. Median (IQR) age was 71 (64-78) years and 470 (68%) had organ confined disease. VH was present in 70 (10.2%) patients. In a median follow-up of 16 months, the incidence of urothelial recurrence, metastasis, and mortality was 26.8%, 15.3%, and 11.8%, respectively. VH was associated with increased risk of metastasis (HR 4.3, P < .0001) and death (HR 2.0, P = .046). In multivariable analysis, VH was noted

OBJECTIVE:To identify trends in complications following robot-assisted radical cystectomy (RARC) using a multi-institutional database, the International Robotic Cystectomy Consortium (IRCC). METHODS:A retrospective review of the IRCC database was performed (2976 patients, 26 institutions from 11 countries). Postoperative complications were categorized as overall or high grade (≥ Clavien Dindo III) and were further categorized based on type/organ site. Descriptive statistics was used to summarize the data. Multivariate analysis (MVA) was used to identify variables associated with overall and high-grade complications.  Cochran-Armitage trend test was used to describe the trend of complications over time. RESULTS:1777 (60%) patients developed postoperative complications following RARC, 51% of complications occurred within 30 days of RARC, 19% between 30-90 days, and 30% after 90 days. 835 patients (28%) experienced high-grade complications. Infectious complications (25%) were the most prevalent, while bleeding (1%) was the least. The incidence of complications was stable between 2002-2021. Gastrointestinal and neurologic postoperative complications increased significantly (P < .01, for both) between 2005 and 2020 while thromboembolic (P = .03) and wound complications (P < .01) decreased. On MVA, BMI (OR 1.03, 95%CI 1.01-1.05, P < .01), prior abdominal surgery (OR 1.26, 95%CI 1.03-1.56, P = .03), receipt of neobladder (OR 1.52, 95%CI 1.17-1.99, P < .01), positive nodal disease (OR 1.33, 95%CI 1.05-1.70, P = .02), length of inpatient stay (OR 1.04, 95%CI 1.02-1.05, P < .01) and ICU admission (OR 1.67, 95%CI 1.36-2.06, P < .01) were associated with high-grade complications. CONCLUSION:Overall and high-grade complications after RARC remained stable between 2002-2021. GI and neurologic complications increased, while thromboembolic and wound complications decreased.

ObjectivesTo evaluate postoperative complications following robot‐assisted radical cystectomy in patients diagnosed with bladder cancer and reveal if there are predictors for postoperative complications.MethodsProspectively collected medical records of 730 robot‐assisted radical cystectomy patients between 2007/04 and 2019/05 in 13 tertiary referral centers were reviewed. Perioperative outcomes were compared between two groups by postoperative complications (complication vs non‐complication). We assessed recurrence‐free survival, cancer‐specific survival, and overall survival between groups. Regression analyses were implemented to identify factors associated with postoperative complications.ResultsAny total and high‐grade complication (Clavien–Dindo grade ≥3) rates were 57.8% and 21.1%, respectively. Patients in complication group had significantly higher proportion of diabetes mellitus (P = 0.048), chronic kidney disease (P = 0.011), dyslipidemia (P < 0.001), longer operation time (P = 0.001), more estimated blood loss (P = 0.001), and larger intraoperative fluid volume (P < 0.001). There was a significant difference in cancer‐specific survival (log‐rank P = 0.038, median cancer‐specific survival: both groups not reached). Dyslipidemia (odds ratio 2.59, P = 0.002) and intraoperative fluid volume (odds ratio 1.0002, P = 0.040) were significantly associated with high‐grade postoperative complications. Diabetes mellitus (odds ratio 1.97, P = 0.028), chronic kidney disease (odds ratio 1.89, P = 0.046), dyslipidemia (odds ratio 5.94, P = 0.007), and intraoperative fluid volume (odds ratio 1.0002, P = 0.009) were significantly associated with any postoperative complications.ConclusionsPatients with diabetes mellitus, chronic kidney disease, dyslipidemia, or a relatively large intraoperatively infused fluid volume are more likely to develop postoperative complications. Patients with postoperative complications might have a possibility of lower cancer‐specific survival rate.

Nicholas Corsi*, Marcus Jamil, Sohrab Arora, Deepansh Dalela, Detroit, MI; Riccardo Auturino, Richmond, VA; Chandru Sundaram, Indianapolis, IN; Robert Uzzo, Philadelphia, PA; Alex Mottrie, Aalst, Belgium; James Porter, Seattle, WA; Daniel Eun, Philadelphia, PA; Koon Rha, Seoul, Korea, Republic of; Amit Satish Bhattu, Miami, FL; Zhenjue Wu, Shanghai, China, People's Republic of; AndreaMinervini, Florence, Italy; Matteo Ferro, Milan, Italy; Giuseppe Simone, Rome, Italy; Ithaar Derweesh, La Jolla, CA; Vitaly Margulis, Dallas, TX; Hooman Djaladat, Los Angeles, CA; Andrew Katims, New York, NY; Firas Abdollah, Detroit, MI

PURPOSE:We sought to evaluate outcomes of lymph node dissection (LND) in patients with upper tract urothelial carcinoma. MATERIALS AND METHODS:We performed a multicenter retrospective analysis utilizing the ROBUUST (for RObotic surgery for Upper Tract Urothelial Cancer Study) registry for patients who did not undergo LND (pNx), LND with negative lymph nodes (pN0) and LND with positive nodes (pN+). Primary and secondary outcomes were overall survival (OS) and recurrence-free survival (RFS). Multivariable analyses evaluated predictors of outcomes and pathological node positivity. Kaplan-Meier analyses (KMAs) compared survival outcomes. RESULTS:A total of 877 patients were analyzed (LND performed in 358 [40.8%]/pN+ in 73 [8.3%]). Median nodes obtained were 10.2 for pN+ and 9.8 for pN0. Multivariable analyses noted increasing age (OR 1.1, p <0.001), pN+ (OR 3.1, p <0.001) and pathological stage pTis/3/4 (OR 3.4, p <0.001) as predictors for all-cause mortality. Clinical high-grade tumors (OR 11.74, p=0.015) and increasing tumor size (OR 1.14, p=0.001) were predictive for lymph node positivity. KMAs for pNx, pN0 and pN+ demonstrated 2-year OS of 80%, 86% and 42% (p <0.001) and 2-year RFS of 53%, 61% and 35% (p <0.001), respectively. KMAs comparing pNx, pN0 ≥10 nodes and pN0 <10 nodes showed no significant difference in 2-year OS (82% vs 85% vs 84%, p=0.6) but elicited significantly higher 2-year RFS in the pN0 ≥10 group (60% vs 74% vs 54%, p=0.043). CONCLUSIONS:LND during nephroureterectomy in patients with positive lymph nodes provides prognostic data, but is not associated with improved OS. LND yields ≥10 in patients with clinical node negative disease were associated with improved RFS. In high-grade and large tumors, lymphadenectomy should be considered.