Introduction: Previous surgery and/or radiation can lead to significant intra-abdominal adhesions and therefore, can add to the complexity of surgery, and render minimally invasive surgery more challenging. We hereby report the perioperative outcomes of patients who underwent robot-assisted radical cystectomy (RARC) and have a history of previous pelvic surgery and/or radiation.
Methods: Retrospective review of our prospectively maintained database between 2005 and 2018. 589 RARCs were identified. Patients were divided into three groups based on surgical complexity; Complexity grade 1 (CG1) included patients who did not have any history of prior pelvic surgery or radiation (n=323); Complexity grade 2 (CG2) included those who had history of a single pelvic surgery or radiation (n=186); and Complexity grade 3 (CG3) included those who had history of 2 or more pelvic surgeries, or one or more pelvic surgery and radiation (n=80). All groups were compared in terms of perioperative characteristics and pathologic outcomes. Multivariate linear and logistic regression models were used to depict the predictors of operative time, =500 ml blood loss, 90-day complications, high grade complications, and readmissions.
Results: Mean age was 69 ± 11 years with a median follow up of 52 months. CG 3 were more likely to have an ASA =3 (CG3: 72% vs CG1: 49% and CG2: 59%, p<0.01), less likely to receive neobladder (CG3: 3% vs CG1: 13%, vs CG2: 6%, p<0.01), more 90-day complications compared (CG3: 74%, CG1: 59%, CG2: 68%, p=0.02), and more high grade complications (CG3: 24%, CG1: 13%, CG2 18%, p=0.03). On multivariate linear and logistic regression models, CG 3 was significantly associated with higher 90-day overall complications (OR 2.18, 95% CI 1.21-3.94, p<0.01) but not estimated blood loss, longer operative time, 90-day high grade complications and readmissions (Table 1).
Conclusions: Higher surgical complexity was associated with higher overall complications, but not estimated blood loss, longer operative time, high grade complications and readmissions. Source of