Robot-assisted radical cystectomy: An expert panel review of the current status and future direction

John W. Davis, Erik P Castle, Raj S. Pruthi, David K. Ornstein, Khurshid A. Guru

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Objective: At the 9th Annual Meeting of the Society of Urologic Oncology (SUO), an expert panel discussed the current status of robot-assisted radical cystectomy (RARC). Materials and methods: The presentations were derived from: (1) review of published literature, unpublished addendums, and SUO abstracts, (2) initial abstract data of pooled results of 528 patients from the International Robot-Assisted Cystectomy Consortium (IRCC), and (3) an internet-based survey of the SUO membership (n = 54) on training and practice patterns related to RARC. Results: Using pathologic assessment of surgical margins as a surrogate for cancer control, the results are favorable with organ confined disease, with select expert series showing no positive margins and the IRCC group reporting 4%. In non-organ-confined disease, select expert series also show no positive margins, while for the IRCC group it was 15%. The median lymph node yield in all series is 12-19 with 5%-33% positive. The S-model robot is preferred for an extended node dissection to the aortic bifurcation. In experienced hands, estimated blood loss is <500 cc, and hospital discharge by postoperative d 4-5. Complications appear similar to open and decrease with experience. In one study comparing RARC to open, pain scales were similar but morphine use was consistently lower for RARC. The technique is most often applied to the bladder and lymph nodes only with a mini-laparotomy for the diversion; technical considerations for female patients were described. The membership surveys showed that 37% of respondents have attempted RARC, but < 20% received robot console training during fellowship. The greatest area of concern was the adequacy of the lymph node dissection in the higher regions-common iliac to peri-caval/aortic. Conclusions: Initial reports of RARC demonstrate feasibility of technique, early oncologic outcomes, and learning curve experiences. Surgeons learning RARC should select patients without clinical evidence of locally advanced disease, and consider a second look open node dissection. Experienced surgeons have demonstrated the possibility of reduced blood loss, opiate requirement, and hospital stay. Moving forward, an international consortium has been organized to address the unmet needs of prospective comparisons with long-term oncologic outcomes, standardized complication reporting, and quality of life.

Original languageEnglish (US)
Pages (from-to)480-486
Number of pages7
JournalUrologic Oncology: Seminars and Original Investigations
Volume28
Issue number5
DOIs
StatePublished - Sep 2010

Fingerprint

Cystectomy
Dissection
Opiate Alkaloids
Lymph Nodes
Direction compound
Venae Cavae
Learning Curve
Lymph Node Excision
Internet
Laparotomy
Morphine
Length of Stay
Urinary Bladder
Quality of Life
Learning
Pain

Keywords

  • Bladder cancer
  • Radical cystectomy
  • Review article
  • Robot-assisted surgery
  • Transitional cell carcinoma

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Robot-assisted radical cystectomy : An expert panel review of the current status and future direction. / Davis, John W.; Castle, Erik P; Pruthi, Raj S.; Ornstein, David K.; Guru, Khurshid A.

In: Urologic Oncology: Seminars and Original Investigations, Vol. 28, No. 5, 09.2010, p. 480-486.

Research output: Contribution to journalArticle

Davis, John W. ; Castle, Erik P ; Pruthi, Raj S. ; Ornstein, David K. ; Guru, Khurshid A. / Robot-assisted radical cystectomy : An expert panel review of the current status and future direction. In: Urologic Oncology: Seminars and Original Investigations. 2010 ; Vol. 28, No. 5. pp. 480-486.
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abstract = "Objective: At the 9th Annual Meeting of the Society of Urologic Oncology (SUO), an expert panel discussed the current status of robot-assisted radical cystectomy (RARC). Materials and methods: The presentations were derived from: (1) review of published literature, unpublished addendums, and SUO abstracts, (2) initial abstract data of pooled results of 528 patients from the International Robot-Assisted Cystectomy Consortium (IRCC), and (3) an internet-based survey of the SUO membership (n = 54) on training and practice patterns related to RARC. Results: Using pathologic assessment of surgical margins as a surrogate for cancer control, the results are favorable with organ confined disease, with select expert series showing no positive margins and the IRCC group reporting 4{\%}. In non-organ-confined disease, select expert series also show no positive margins, while for the IRCC group it was 15{\%}. The median lymph node yield in all series is 12-19 with 5{\%}-33{\%} positive. The S-model robot is preferred for an extended node dissection to the aortic bifurcation. In experienced hands, estimated blood loss is <500 cc, and hospital discharge by postoperative d 4-5. Complications appear similar to open and decrease with experience. In one study comparing RARC to open, pain scales were similar but morphine use was consistently lower for RARC. The technique is most often applied to the bladder and lymph nodes only with a mini-laparotomy for the diversion; technical considerations for female patients were described. The membership surveys showed that 37{\%} of respondents have attempted RARC, but < 20{\%} received robot console training during fellowship. The greatest area of concern was the adequacy of the lymph node dissection in the higher regions-common iliac to peri-caval/aortic. Conclusions: Initial reports of RARC demonstrate feasibility of technique, early oncologic outcomes, and learning curve experiences. Surgeons learning RARC should select patients without clinical evidence of locally advanced disease, and consider a second look open node dissection. Experienced surgeons have demonstrated the possibility of reduced blood loss, opiate requirement, and hospital stay. Moving forward, an international consortium has been organized to address the unmet needs of prospective comparisons with long-term oncologic outcomes, standardized complication reporting, and quality of life.",
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