Marco Moschini1, Giuseppe Simone2, Arnulf Stenzl3, Inderbir S Gill4, James Catto5. 1. Unit of Urology/Division of Oncology, IRCCS Ospedale San Raffaele, URI Milan, Milan, Italy. Electronic address: marco.moschini87@gmail.com. 2. Department of Urology, "Regina Elena" National Cancer Institute, Rome, Italy. 3. Department of Urology, University Hospital Tübingen, Tübingen, Germany. 4. University of Southern California Institute of Urology, Keck School of Medicine, Catherine and Joseph Aresty Department of Urology, Los Angeles, CA, USA. 5. Academic Urology Unit, University of Sheffield, Sheffield, UK.
Abstract
CONTEXT: Radical cystectomy (RC) is a highly complex procedure with multiple risks for perioperative complications. OBJECTIVE: We reviewed the literature to report perioperative outcomes and the incidence of complications in contemporary RC series. We focused on the potential impact of surgical approach and surgeon volume on these outcomes. EVIDENCE ACQUISITION: A systematic literature search was performed in December 2015 using the Medline, Embase, and Web of Science databases for articles published in English between 2005 and 2015. The search strategy included the terms complications, cystectomy, robotic assisted radical cystectomy, and surgical volume, alone or in combination. Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. EVIDENCE SYNTHESIS: Our searches retrieved 49 papers. Open RC (ORC) and robot-assisted RC (RARC) are morbid procedures with consistent risk of perioperative complications (mean weighted incidence: 48.7%; range: 27.0-72.5%). Higher hospital and surgeon volumes were associated with reduced risks of perioperative complications. Prior robotic expertise in radical prostatectomy showed a beneficial protective risk on development of complications after RARC. Surgical volume appears to be a good predictor of safety in ORC and RARC. RARC is associated with reduced estimated blood loss and lower perioperative transfusion rates compared with ORC. Further evidence is needed to support the reproducibility of intracorporeal diversion during RARC, beyond large tertiary referral centers. Several strategies have been demonstrated to be effective for reducing the risk of incurring perioperative complications and should be pursued by physicians. CONCLUSIONS: Despite improvements in quality of care, RC remains a challenging procedure with high morbidity, regardless of surgical approach. RARC is a safe procedure with potential advantages in terms of reduced blood loss and transfusion rates. Surgical volume appears to be related to the improvement of perioperative outcomes and complications. PATIENT SUMMARY: Radical cystectomy is a challenging and morbid procedure. The robotic approach has gained popularity and proved to be safe and effective in tertiary referral centers, although further studies are needed to confirm its wide reproducibility. Centers with higher surgical volume have lower incidence of perioperative complications.
CONTEXT: Radical cystectomy (RC) is a highly complex procedure with multiple risks for perioperative complications. OBJECTIVE: We reviewed the literature to report perioperative outcomes and the incidence of complications in contemporary RC series. We focused on the potential impact of surgical approach and surgeon volume on these outcomes. EVIDENCE ACQUISITION: A systematic literature search was performed in December 2015 using the Medline, Embase, and Web of Science databases for articles published in English between 2005 and 2015. The search strategy included the terms complications, cystectomy, robotic assisted radical cystectomy, and surgical volume, alone or in combination. Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. EVIDENCE SYNTHESIS: Our searches retrieved 49 papers. Open RC (ORC) and robot-assisted RC (RARC) are morbid procedures with consistent risk of perioperative complications (mean weighted incidence: 48.7%; range: 27.0-72.5%). Higher hospital and surgeon volumes were associated with reduced risks of perioperative complications. Prior robotic expertise in radical prostatectomy showed a beneficial protective risk on development of complications after RARC. Surgical volume appears to be a good predictor of safety in ORC and RARC. RARC is associated with reduced estimated blood loss and lower perioperative transfusion rates compared with ORC. Further evidence is needed to support the reproducibility of intracorporeal diversion during RARC, beyond large tertiary referral centers. Several strategies have been demonstrated to be effective for reducing the risk of incurring perioperative complications and should be pursued by physicians. CONCLUSIONS: Despite improvements in quality of care, RC remains a challenging procedure with high morbidity, regardless of surgical approach. RARC is a safe procedure with potential advantages in terms of reduced blood loss and transfusion rates. Surgical volume appears to be related to the improvement of perioperative outcomes and complications. PATIENT SUMMARY: Radical cystectomy is a challenging and morbid procedure. The robotic approach has gained popularity and proved to be safe and effective in tertiary referral centers, although further studies are needed to confirm its wide reproducibility. Centers with higher surgical volume have lower incidence of perioperative complications.
Authors: Marco Moschini; Evanguelos Xylinas; Stefania Zamboni; Agostino Mattei; Günter Niegisch; Evan Y Yu; Aristotelis Bamias; Neeraj Agarwal; Srikala S Sridhar; Cora N Sternberg; Ulka N Vaishampayan; Jonathan E Rosenberg; Joaquim Bellmunt; Matthew D Galsky; Francesco Montorsi; Andrea Necchi Journal: Eur Urol Oncol Date: 2019-07-13
Authors: Nathan A Brooks; Andrea Kokorovic; John S McGrath; Wassim Kassouf; Justin W Collins; Peter C Black; James Douglas; Hooman Djaladat; Siamak Daneshmand; James W F Catto; Ashish M Kamat; Stephen B Williams Journal: World J Urol Date: 2020-07-09 Impact factor: 4.226
Authors: Jacob Taylor; Xiaosong Meng; Audrey Renson; Angela B Smith; James S Wysock; Samir S Taneja; William C Huang; Marc A Bjurlin Journal: Ther Adv Urol Date: 2019-09-19
Authors: Marco Moschini; Stefania Zamboni; Francesco Soria; Romain Mathieu; Evanguelos Xylinas; Wei Shen Tan; John D Kelly; Giuseppe Simone; Anoop Meraney; Suprita Krishna; Badrinath Konety; Agostino Mattei; Philipp Baumeister; Livio Mordasini; Francesco Montorsi; Alberto Briganti; Andrea Gallina; Armando Stabile; Rafael Sanchez-Salas; Xavier Cathelineau; Michael Rink; Andrea Necchi; Pierre I Karakiewicz; Morgan Rouprêt; Anthony Koupparis; Wassim Kassouf; Douglas S Scherr; Guillaume Ploussard; Stephen A Boorjian; Yair Lotan; Prasanna Sooriakumaran; Shahrokh F Shariat Journal: J Clin Med Date: 2019-08-09 Impact factor: 4.241