The feasibility and safety of robotic-assisted salvage radical cystectomy

To evaluate the feasibility and safety of robotic-assisted salvage radical cystectomy (RA-SRC).

We retrospectively searched the prospectively collected surgical database of two highly experienced robotic urological surgeons for cases of RA-SRC, defined as RARC performed post-previous pelvic RT for palliative or oncologic treatment purposes. Collected data included demographic and clinical information and outcome measures including operative course, hospital stay and complications.

Eighteen patients were included in the current analysis. All patients had previous RT to the pelvis with 12 patients also having prior radical pelvic surgery. Indications for salvage cystectomy were either palliation (n = 12) or oncological (MIBC or high risk NMIBC, n = 6). There were no intraoperative complications and no conversions to open surgery. Ninety day postoperative complications were recorded in 11 patients (61.1%), with major complications (Clavien-Dindo grades 3 and 4) in three patients (16.6%). After a median follow-up of 43.5 months, one late postoperative complication was observed requiring surgical intervention.

Our data, together with the limited published data from other cohorts of RA-SRC, suggest that in experienced hands, RA-SRC is feasible, with intraoperative and perioperative complication rates that are lower than the published data for open SRC and are equivalent to open primary RC. These data will contribute to treatment decision making both in patients with post-pelvic radiation symptoms requiring palliation and patients with MIBC considering or treated with trimodal treatment.