Robot-assisted Cystectomy with Intracorporeal Urinary Diversion After Pelvic Irradiation for Prostate Cancer: Technique and Results from a Single High-volume Center.

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Radiation therapy (RT) for prostate cancer (PCa) treatment is burdened by high rates of late urinary adverse events (UAEs). The feasibility of robot-assisted cystectomy (RAC) with intracorporeal urinary diversion (ICUD) for treatment of high-grade UAEs has never been assessed.To report perioperative outcomes, early (≤90 d) and late (>90 d) complications among patients undergoing RAC for UAEs after RT.We retrospectively evaluated 32 patients undergoing RAC with ICUD for UAEs in a single tertiary centre.Surgery was performed using a da Vinci Xi system with adaptation for the primary treatment.Perioperative outcomes included estimated blood loss (EBL), operative time (OT), intraoperative complications, and length of stay (LOS). Data for early and late postoperative complications were collected using the quality criteria recommended by the European Association of Urology. Univariate logistic regressions were performed to test the effect of baseline and perioperative characteristics on early postoperative complications.The median age-adjusted Charlson comorbidity index (ACCI) was 6 (IQR 5-7). The indication for RAC was hemorrhagic radiation cystitis in 29 cases (91%), contracted bladder in two cases (6.2%), and urinary fistula in one case (3.1%). The median EBL, OT, and LOS were 250 ml, 330 min, and 10 d, respectively. A total of 31 (97%) patients received an ileal conduit. The 90-d rate of Clavien-Dindo grade ≥IIIa complications was 28%. The late complication rate was 46% and the perioperative mortality rate was 0%. On univariate analyses, ACCI was the only parameter correlated with the risk of early complications (odds ratio 1.75, 95% confidence interval 1.05-2.9; p =  0.03). The median follow-up was 30 mo (IQR 15-40). The lack of comparison with open cystectomy represents the main limitation.RAC for UAEs in patients with a history of pelvic irradiation is a feasible option in high-volume centers. The use of new technologies can help to overcome some of the technical difficulties and reduce the risk of perioperative and late complications.We report our experience with robot-assisted surgery for removal of the bladder in the management of urinary problems after radiation therapy for prostate cancer. When performed by highly experienced surgeons, this is a feasible procedure with outcomes and early and late complication rates that are acceptable.

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Authors: Pietro Piazza, Giuseppe Rosiello, Victor Tames Chacon, Stefano Puliatti, Marco Amato, Rui Farinha, Riccardo Schiavina, Eugenio Brunocilla, Camille Berquin, Dries Develtere, Celine Sinatti, Hannah Van Puyvelde, Ruben De Groote, Peter Schatteman, Geert De Naeyer, Frederiek D’Hondt, Alexandre Mottrie