Prediction of 30-d Clavien grade ≥3 complication rate in Robot-Assisted Radical Cystectomy with totally intracorporeal urinary diversion

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Introduction & Objective:
Minimally invasive radical cystectomy with totally intracorporeal urinary diversion (UD) is a challenging procedure that is gaining popularity thanks to robotic platform. In this study we analyzed a cohort of 100 consecutive cases of Robot-Assisted Radical Cystectomies (RARCs) to identify predictors of 30-d severe complications.
Materials and Methods:
Between August 2012 and September 2014 100 patients underwent RARC with totally intracorporeal UD. All procedures were performed by the same surgical team. Baseline, and perioperative outcomes were collected and analyzed. Univariable and multivariable Cox analyses were performed to identify predictors of 30-d Clavien grade ≥3 complications.
The overall incidence of 30-d complications was 50%, while the 30-d Clavien grade ≥3 complications rate was 21%.
At univariable Cox analysis, age (continuous, p<0.001), learning curve (each unit increase; p<0.001), ASA score (p<0.001), body mass index (p<0.001), preoperative hemoglobin levels (p<0.001), estimated glomerular filtration rate(e-GFR) (p=0.001) and UD (p=0.004) were significant predictors of 30-d grade ≥3 Clavien complications occurrence (Table 1). At multivariable Cox analysis, the number of procedures performed (each unit increase) and the UD performed (ileal conduit vs. orthotopic ileal neobladder) were the only independent predictors of lower 30-d grade ≥3 complications rate (p=0.03 [HR 0.978, 95%CI 0.96-0.99] and p=0.039 [HR 0.10, 95% CI 0.12-0.89] , respectively) (Table 2). Conclusions: Learning curve and orthotopic neobladder are independent predictors of severe complications after RARC with totally intracorporeal UD. ==fine abstract==