Evaluation of perioperative complications and outcomes of robot-assisted radical nephroureterectomy and bladder cuff excision in a tertiary center

Purpose: For patients with localized upper tract urothelial carcinoma (UTUC), radical nephroureterectomy with ipsilateral bladder cuff excision (RNU + BCE) is the standard treatment. In recent years, robot-assisted RNU with BCE (RaRNU + BCE) has been another choice of surgical intervention. This article was aimed to analyze the efficacy and perioperative outcomes regarding RaRNU + BCE through a single institutional experience. Patients and Methods: From March 2012 to November 2015, a total of 54 patients with UTUC were treated with RaRNU + BCE at Taipei Veterans General Hospital. We collected demographic data, histopathological reports, perioperative complications, and oncologic outcomes. Results: A total of 54 patients were included in our study. The mean age was 71.9 ± 9.9 (range 48-88) and the mean body mass index was 23.5 ± 2.9 (range: 16.4-30.8). The mean operating time was 314 min (RaRNU: 133.9 ± 41.4 min and RaBCE: 72.9 ± 25.7 min). The mean first docking time was 26.8 ± 7.7 min and the mean second docking time was 16.5 ± 6.7 min. The mean EBL was 87.7 ml. Pathological stage distribution was 22.2%, 27.8%, 13.0%, 31.5%, and 5.6% in pTa, pT1, pT2, pT3, and pT4, respectively. Complications occurred in 7 cases (13%), with 4 Grade I and 3 Grade II by Clavien-Dindo classification. Positive tumor involvement at bladder cuff was noted in three patients, and the bladder recurrence rate was 29.6%. Local recurrence, lymph node metastasis, and distant metastasis were all noted for two patients, respectively. The cancer-specific and overall survival rate was 98.1% and 96.3%. Conclusions: Our experience showed that RaRNU + BCE is a technically feasible and safe procedure for selected patients with UTUC.