Learning curve for intracorporeal robotic Padua ileal bladder: 10‐year functional assessment from a high‐volume single‐centre series

Author:

Tuderti Gabriele1ORCID,Mastroianni Riccardo1,Anceschi Umberto1,Bove Alfredo Maria1,Brassetti Aldo1,Ferriero Mariaconsiglia1ORCID,Misuraca Leonardo1,Flammia Rocco Simone1ORCID,Proietti Flavia1,D'Annunzio Simone1,Leonardo Costantino1,Guaglianone Salvatore1,Anselmi Marianna1,Zampa Ashanti1,Torregiani Giulia1,Gallucci Michele1,Simone Giuseppe1ORCID

Affiliation:

1. Department of Urology IRCCS ‘Regina Elena’ National Cancer Institute Rome Italy

Abstract

ObjectivesTo assess the impact of the learning curve (LC) on perioperative and long‐term functional outcomes of a consecutive single‐centre series of robot‐assisted radical cystectomy with Padua intracorporeal orthotopic neobladder.Patients and MethodsPatients treated between 2013 and 2022 were included, with ≥1 year of follow‐up. The entire cohort was divided in tertiles. Categorical and continuous variables were compared. Joinpoint regression analysis was used to identify significant changes over the decade in linear slope of the 1‐year day‐ and night‐time continence. Uni‐ and multivariable Cox regression analyses identified predictors of day‐ and night‐time continence recovery. Day‐time continence was defined as ‘totally dry’ (no pads), night‐time continence as pad wetness ≤50 mL (one safety pad).ResultsOverall, 200 patients were included. The mean hospital stay (P = 0.002) and 30‐day complications (P = 0.04) significantly reduced over time; the LC significantly impacted on Trifecta achievement (P < 0.001). The 1‐year day‐ and night‐time continence probabilities displayed a significant improving trend (day‐time continence annual average percentage change [AAPC] 11.45%, P < 0.001; night‐time continence AAPC 10.05%, P = 0.009). The LC was an independent predictor of day‐ (hazard ratio [HR] 1.008; P < 0.001) and night‐time continence (HR 1.004; P = 0.03) over time.ConclusionPatients at the beginning of the LC had significantly longer hospitalisations, more postoperative complications, and lower Trifecta rates. At the 10‐year analyses, we observed a significant improving trend for both the 1‐year day‐ and night‐time continence probabilities, highlighting the crucial role of the LC. However, we are unable to assess the case volume needed to achieve a plateau in terms of day‐ and night‐time continence rates.

Publisher

Wiley

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