V06-04: Sex-sparing vs standard Robot Assisted Radical Cystectomy with Intracorporeal Padua Ileal Neobladder in female: step-by-step surgical technique, perioperative, oncologic and functional outcomes
Despite the widespread use of Robot assisted radical cystectomy (RARC), there is paucity of data concerning outcomes of Sex-sparing RARC with intracorporeal ileal neobladder (iN) performed in female patients. In this video we demonstrate surgical steps of standard vs sex-sparing robot assisted radical cystectomy, and we compare perioperative and functional outcomes of both approaches.
Our single center IRB approved bladder cancer database was queried for Female, RARC, iN and Sex-sparing, including patients treated between January 2013 and June 2018. Key surgical steps are: isolation of the ureters, preparation of umbilical, uterine and superior vesical arteries. In Sex-sparing approach development of vesico-uterine plane is performed, and uterine feeding arteries are preserved, while in standard procedure uterine and vesical pedicle are transected close to their origins from iliac internal artery. Notably, sex-sparing RARC allows to preserve utero-vaginal component of hypogastric plexus that is almost sacrificed during standard RARC. Baseline demographic, clinical, perioperative, pathologic and functional data were collected and reported. Kaplan-Meier method was performed to compare day-time continence recovery probabilities between Sex-sparing and standard RARC cohorts.
Out of 47 patients included, 11 underwent sex-sparing RARC (23.4%). The two cohorts were homogeneous for all baseline, clinical and pathologic features (all p≥0.14), except for age, being sex-sparing patients significantly younger (47.1 vs 61.7 yrs, p<0.001). Perioperative complications and hospital stay were comparable between groups (p=0.25 and p=0.67, respectively). With regard to functional outcomes, no significant differences were observed for last estimated glomerular filtration rate (p=0.64), neobladder stone formation rate (p=0.93) and 1-yr incidence of ureteroileal strictures (p=0.56). Day-time continence recovery probability was significantly higher in Sex-sparing cohort (1-yr rate 90.9% vs 74%, log-rank p=0.02). A trend towards a significantly higher adoption of intermittent self-catheterization was observed in Sex-sparing cohort (p=0.07). At a median follow-up of 19.9 months, no patients of Sex-sparing cohort developed recurrences.</p>
In select cohort of patients, Sex-sparing RARC-iN seems an oncologically sound procedure, associated with favorable perioperative and functional outcomes. Due to small sample size and intrinsic selection biases, oncologic and functional outcomes of sex-sparing RARC-iN should be assessed in larger cohorts, while outcomes comparison with conventional RARC-iN technique requires prospective randomized trials