Introduction:

To identify trends in complications following robot-assisted radical cystectomy (RARC) using a multi-institutional database, the International Robotic Cystectomy Consortium (IRCC).

Methods:

A retrospective review of the IRCC database was performed (2976 patients, 26 institutions from 14 countries). Postoperative complications were categorized as overall or high grade  (≥ Clavien Dindo III) and were further categorized based on type. Descriptive analysis was used to compare perioperative data. Multivariate analysis (MVA) was used to identify variables associated with any and high-grade complications.  Cochran-Armitage trend test was used to depict change in complications over time.

Results:

Of the 2976 cohort, 1777(60%) patients developed postoperative complications following RARC. 1168(39%) patients experienced postoperative complications within 30 days and 1406(47%) within 90 days. A total of 835 patients(28%) experienced high-grade complications, with 13% within 30 days and 19% within 90. Infection(25%) was the highest reported complication, while bleeding(1%) was the lowest (Table 1a). On MVA, BMI(p<0.01), prior abdominal surgery(p<0.01), number of dissected lymph nodes(p<0.01), length of inpatient stay(p<0.01), and ICU admission(p<0.01) were associated with postoperative complications, while BMI(p<0.01), prior abdominal surgery(p=0.03), receipt of neobladder(p<0.01), length of inpatient stay(p<0.01), ICU admission(p<0.01), and number of positive lymph nodes(p=0.02) were associated with high grade complications (Table 1b). Overall, incidence of complications was stable between 2005 and 2020(p>0.05) (Figure 1). Gastrointestinal and neurologic postoperative complications increased significantly (p<0.01) while development of thromboembolism(p=0.03) and wound complications(p<0.01) decreased. Infections, bleeding, strictures, GU, pulmonary, cardiovascular complications remained stable(p>0.05) (Figure 1b).

Conclusion:

While overall complication after RARC remained stable, GI and neurologic complications have increased significantly between 2005 and 2020. Despite the evolution of the surgical technique RARC remains a morbid procedure requiring referral to high volume centers.

Funding: Roswell Park Alliance Foundation and The Vattikuti Foundation Collective Quality Initiative