Surgical outcomes and predictive value for major complications of robot‐assisted radical cystectomy of real‐world data in a single institution in Japan

Abstract

ObjectiveThe objective of the study was to describe the surgical outcome of robot‐assisted radical cystectomy and predictive factors for major complications in real‐world clinical practice at a single institution in Japan.MethodsWe retrospectively analyzed 208 consecutive patients undergoing robot‐assisted radical cystectomy at our institution between 2019 and 2023. Patient and disease characteristics, intraoperative details, and perioperative outcomes were reviewed. Postoperative complications were defined as minor complications (Clavien–Dindo grades 1–2) or major complications (grades 3–5). Predictors of complications were examined using multivariable logistic analysis.ResultsOverall, 147 men and 61 women, median age 70 years (interquartile range, 62–77), were included in this study. Median operative time and estimated blood loss were 8.4 h and 185 mL, respectively; 11 patients (5%) received intraoperative blood transfusions. For urinary diversions, ileal conduit, neobladder, and cutaneous ureterostomy were performed in 153 (74%), 49 (24%), and 6 (3%) patients, respectively. Urinary diversions were primarily performed with extracorporeal urinary diversion. In total, 140 complications occurred in 111 patients (53%) within 30 days. Of these patients, 31 major complications occurred in 28 patients, and one perioperative death (0.5%) with a postoperative cardiovascular event. Multivariable analysis showed only prolonged operative time (odds ratio: 4.34, 95% confidence interval: 1.82–10.35, p < 0.01) was the independent risk factor for major complications.ConclusionsThis study reports surgical outcomes at our single institution. Prolonged operative time was a significant prognostic factor for major complications. As far as we know, this study reports the largest number of robot‐assisted radical cystectomy cases at a single center in Japan.