V1857: Challenging Cases of Robotic Assisted Radical Cystectomy following Radiotherapy or Vascular Surgery

Video

Introduction and Objectives
Robotic-assisted radical cystectomy (RARC) is increasingly utilized for the management of invasive bladder cancer. However, the feasibility of RARC in the setting of prior radiotherapy and vascular surgery has yet to be determined. We describe the technical challenges associated with these cases and compare outcomes with the entire RARC cohort at the University of Southern California.

Methods
Between August 2009 and October 2012 58 patients underwent RARC at our institution. We compared the outcomes of 5 patients who had prior radiotherapy or vascular surgery with the rest of the cohort. The technique of RARC has been standardized at USC, and includes an extended pelvic lymph node dissection and intracorporeal urinary diversion. Demographic, perioperative and pathological parameters were collected.

Results
All five patients were male with a median age of 75. Three patients received radiotherapy for prostate cancer and two patients with prior vascular surgery including abdominal aortic aneurysm repair in one patient and aorto-bifemoral bypass graft placement in the other one.



Of the 5 patients, median EBL was 250 ml (range: 60 - 250), median operative time was 7 hrs (range: 6 - 8.9) and median hospital length of stay was 8 days (range: 5 - 19). There were no transfusions. One patient had a Clavien grade 1 and one patient had Clavien grade 3a complication.



Comparing these 5 patients with the entire group undergoing RARC, there was no fifference in complications, estimated blood loss, or hospital length of stay.

Conclusions
RARC in the setting of prior radiotherapy or vascular surgery is safe and feasible.

Funding: none