The lymph node yield during robot‐assisted radical cystectomy

Abstract

OBJECTIVE: To evaluate the lymph node yield (LNY) during robot-assisted radical cystectomy (RC), as it has been questioned as to whether robot assistance allows adequate pelvic LN dissection (LND), especially during the initial experience. PATIENTS AND METHODS: In all, 67 consecutive patients were selected for robot-assisted RC and LND with open urinary diversion from October 2005 to November 2007. Data was collected prospectively in a standard fashion as part of a quality assurance programme. Nine patients were excluded (three had unresectable disease and six underwent palliative cystectomy) and the remainder were divided into five groups. Data included demographics, operative variables, complications and pathological outcomes. Evidence of the LNY curve was examined using nonlinear regression to compare the number of LNs obtained. RESULTS: The mean (range) patient age was 67 (36-90) years and the mean body mass index (BMI) was 27 (17-45) kg/m(2). The mean operative duration for the robot-assisted pelvic LND was 44 (19-85) min. There was one postoperative complication that required exploration for vascular injury. The mean number of LNs retrieved was 18 (6-43). The mean LNY for each of the five groups was 13, 16, 21, 19 and 23, respectively, and neither BMI nor previous major abdominal surgery affected LNY. CONCLUSION: Robot-assisted RC with pelvic LND was performed safely. LNY was oncologically acceptable and increased with experience.