MP46-10: Impact of learning curve on perioperative, oncologic and functional outcomes of robot assisted radical cystectomy with intracorporeal orthotopic neobladder: Single center analysis
Introduction: The aim of this study was to assess the role of learning curve (LC) on perioperative, oncologic and functional outcomes of a single center series of Robotic Cystectomy and intracorporeal neobladder (RARC-ION) Methods: The study population included all patients treated between January 2012 and September 2020. The entire cohort was divided in tertiles related to the time of surgery, to assess the effect of LC on the outcomes evaluated, including Trifecta achievement. Baseline, preoperative and perioperative data distribution across tertiles were assessed. Categorical and continuous variables among the three subgroups were compared with Chi square and ANOVA tests, respectively Results: Overall, 192 patients were included. Operative time (p=0.05) and hospital stay (p=0.002) decreased significantly over time.Concerning perioperative complications, after an initial higher rate in the I tertile (low grade 39.7%,high grade 23.8%), since the II tertile decreased and remained stable over time, especially for Clavien = 3 (II tertile 6.3%, III tertile 9.1%) (p=0.007).In terms of renal function impairment,we detected an improving trend in maintaining an eGFR > 45 ml/min during follow-up (new-onset of CKDstage=3b 23.8%, 17.5% and 10.6% in I,II and III tertile).Trifecta achievement was significantly higher in II and III tertiles (I:49.2%; II:77.8%; III:65.2%,p=0.004).Although 2-yr CSS rate did not significantly differ between the groups, an improving trend across the tertiles (I: 63.5%, II: 75.9%; III: 76.2%, p=0.22) is observed.In terms of Day- time continence recovery at 12-mo follow-up, after a lower rate in the I tertile(75.9%), the day-time continence rate remained stable over 80% in patients belonging to the II (82.5%) and III (81.3%) tertile. Conclusions: Patients receiving RARC-iON are exposed to worse perioperative and functional results at the beginning of the learning curve. A strict selection of patients and the standardization of surgical steps may turn into rapid and stable improvement of key outcomes for this complex procedure. SOURCE OF Funding: none
