Is patient outcome compromised during the initial experience with robot‐assisted radical cystectomy? Results of 164 consecutive cases

Abstract

Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? There is suggestion in the literature that patient outcomes are linked to surgeon volume and/or experience. This has become particularly relevant in the examination of robot‐ assisted radical prostatectomy in the treatment of men with localized prostate cancer, where some have advocated a "minimum" number of cases necessary to become proficient. The current study demonstrates that, in the treatment of locally advanced bladder cancer, sequential robot‐assisted radical cystectomy case number was not associated with an increased incidence of complications, blood loss, positive surgical margins, or survival in a single high‐volume institution. OBJECTIVE • Robot‐assisted radical cystectomy (RARC) remains controversial in terms of oncologic outcomes, especially during the initial experience. The purpose of this study was to evaluate the impact of initial experience of robotic cystectomy programs on oncologic outcomes and overall survival. PATIENTS AND METHODS • Utilizing a prospectively maintained, single institution robotic cystectomy database, we identified 164 consecutive patients who underwent RARC since November 2005. • After stratification by age group, gender, pathologic T stage, lymph node status, surgical margin status, and sequential case number; we used chi‐squared analyses to correlate sequential case number to operative time, surgical blood loss, lymph node yield, and surgical margin status. • We also addressed the relationship between complications and sequential case number. We then utilized Cox proportional hazard modeling and Kaplan‐Meier survival analyses to correlate variables to overall mortality. RESULTS • Sequential case number was not significantly associated with increased incidence of complications, surgical blood loss, or positive surgical margins ( P = 0.780, P = 0.548, P = 0.545). Case number was, however, significantly associated with shorter operative time and mean number of lymph nodes retrieved ( P < 0.001, P < 0.001). • Sequential case number was not significantly associated with survival; however, tumour stage, the presence of lymph node metastases, and positive surgical margins were significantly associated with death. • Although being the largest of its kind, this was a small study with short follow‐up when compared to open cystectomy series. CONCLUSION • Initial experience with RARC did not affect the incidence of positive surgical margins, operative/postoperative complications, or overall survival in a single‐institution series.