Robotic Assisted Radical Cystectomy with Intra-corporeal Urinary Diversion:

A Single Center Experience

Chyau-Wen Lin¹, Tzu-Hao Huang^1,2, Tzu-Ping Lin^1,2, Hsiao-Jen Chung^1,2, William J. Huang^1,2

1Department of Urology, Taipei Veterans General Hospital, Taiwan

2Department of Urology, School of Medicine and Shu-Tien Urological Institute, National Yang-Ming Chiao-Tung University, Taipei, Taiwan

機械手臂膀胱根除與體內重建尿液分流手術之經驗分享

林巧文¹ 黃子豪¹² 林子平¹² 鍾孝仁¹² 黃志賢¹²

1台北榮民總醫院泌尿部

2 國立陽明交通大學醫學院泌尿學科及書田泌尿科學研究中心

Introduction

Radical cystectomy is a standard treatment for eligible patients diagnosed with muscle invasive bladder cancer (MIBC) and, under some circumstances, non-muscle invasive bladder cancer (NMIBC). Robotic assisted radical cystectomy (RaRC) with intra-corporeal urinary diversion, including ileal conduit or neobladder, has gradually gained popularity as the maturity of minimal invasive surgery. Hence, we would like to share our experience of RaRC with intra-corporeal urinary diversion.

Material and Methods

This is a single center retrospective case series. We recruited all the patients who received RaRC with intra-corporeal urinary diversion, including ileal conduit and neobladder between 2019/01 and 2024/01. Clinical data of peri-operative variables was collected. IBM SPSS 26^th version was employed for statistical analysis.

Results

27 patients received RaRC with intra-corporeal urinary diversion during study period. 14 patients received ileal conduit reconstruction as urinary diversion. Among this group, 8 of them were male while the remaining 6 were female. Median age was 75. The average operation time was 798.4 minutes (SD=115.5), and the average console time was 524 minutes (SD=119.5). Median time to oral intake was POD 3. Median ureter stent, including double J and single J, was POD 11. Median length of stay was 14.5 days.

Of 13 patients who received neobladder as urinary diversion, only 2 were female while the remaining 11 patients were male. Median age was 64.3. The average operation time was 944.5 minutes (SD=130), and the average console time was 735.7 minutes (SD=132.69). Median time to liquid intake was POD 4 . Median ureter stent, including double J and single J, was POD 42.5. Median urethral catheter indwell time was 19 days. Median length of stay was 24 days.

The median follow-up time for the entire cohort was 559 days (IQR: 201-796). Pre-operative clinical staging was predominately T2 (55.6%, n=15). There were 20 patients received neoadjuvant systemic treatment, including Gemcitabine + Cisplatin, Pembrolizumab, Linrodostat or Enfortumab vedotin. 2 patients had received partial cystectomy in the past. The most common post-operative complications within 30 days were wound infection and urinary tract infection, and that within 90 days was urinary tract infection. Margin positive was reported in two patients, who both received ileal conduit as urinary diversion. To date, one patient was reported with ureter-conduit anastomotic stricture, and received re-anastomosis two years later.

7 patients had disease progression (median time to progression: 346 days), and five of them died of the disease (median time to death: 675 days).

Conclusion

In conclusion, our study highlights the feasibility and peri-operative outcomes of RaRC with intra-corporeal urinary diversion, including ileal conduit and neobladder reconstructions. Our findings suggest that RaRC can be safely performed with acceptable complication rates. Long-term follow-up is warranted to further evaluate the efficacy of these procedures in managing bladder cancer.