Robotic-assisted radical cystectomy: the first multicentric Brazilian experience

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Radical cystectomy is a standard treatment for muscle-invasive bladder cancer.
• Robotic radical cystectomy (RARC) offers potential advantages in minimally invasive surgery.
• Data on RARC learning curves and outcomes in Brazil are limited.

Purpose of the Study:

• To report the first multicentric Brazilian series of robotic radical cystectomy (RARC).
• To analyze the learning curve and associated intra- and postoperative outcomes of RARC.
• To evaluate the safety and efficacy of RARC in a Brazilian cohort.

Main Methods:

• Retrospective analysis of 37 RARC cases prospectively collected across four Brazilian centers (2013-2019).
• Inclusion of patient demographics, pathological tumor and nodal status, and intra/postoperative outcomes.
• Statistical analysis using IBM SPSS version 25.

Main Results:

• 83% of patients had muscle-invasive bladder cancer; 17% had high-grade, recurrent non-muscle-invasive tumors.
• Median operative time was 420 minutes (console time 300 minutes); median blood loss was 350 ml with a 10% transfusion rate.
• High rates of negative surgical margins (95%) and excellent short-term survival (95-98%) were observed. Complication rates (Clavien grades) were reported, with 16% experiencing Clavien 1-2 complications.

Conclusions:

• This multicentric series represents the first RARC learning curve report in Brazil.
• Despite being a challenging procedure, RARC can be safely and effectively performed by experienced surgeons.
• RARC demonstrates favorable oncological and perioperative outcomes in the Brazilian setting, supporting its adoption in high-volume centers.