MP03-01: Robot-Assisted Radical Cystectomy with Extracorporeal Urinary Diversion does not Increase Ureteroenteric Stricture Rate: Outcomes from a Randomized Trial comparing Open versus Robotic Cystectomy

Chun Huang, Moose Jaw, Canada, Melissa Assel, Benjamin Beech*, Nicole Benfante, Daniel Sjoberg, Jonathan Coleman, Guido Dalbagni, Harry Herr, S. Machele Donat, Vincent Laudone, Andrew Vickers, Bernard Bochner, Alvin Goh, New York, NY

Introduction: Robot-assisted radical cystectomy is increasingly used to treat bladder cancer. There have been reports of higher stricture risks compared to open cystectomy. We analyzed stricture risk in patients randomized to open or robotic cystectomy with extracorporeal urinary diversion.

Methods: We included 118 patients randomized to robotic (n=60) or open (n=58) cystectomy at a single, high-volume institution. Urinary diversion was performed by experienced open surgeons. Stricture was defined as non-malignant obstruction on imaging, corroborated by clinical status, and requiring procedural intervention. The risk of stricture within 1 year was compared between groups using Fisher’s exact test.

Results: Fifty-eight and 60 patients were randomized to robotic and open cystectomy, respectively. We identified 5 strictures, all in the open group. In patients with at least 1 year of follow-up, the increase in risk of stricture from open surgery was 9.3% (95% CI 1.5%, 17%). Of the 5 strictures, 3 were managed endoscopically while 2 required open revision. There was no evidence that perioperative grade 3-5 complication were associated with development of a stricture (p=1) and no evidence of a difference in 24-month estimated glomerular filtration rate between arms (p=0.15).

Conclusions: In this study at a high volume center, robotic cystectomy with extracorporeal urinary diversion achieved excellent ureteral anastomotic outcomes. Although stricture risk was higher in the open group, risk was low in both arms. Purported increased risk of stricture is not a reason to avoid the robot-assisted radical cystectomy. Future research should examine the impact of different surgical techniques and operator experience on the risk of stricture, especially as more intracorporeal diversions are performed.

Source of Funding: This study was supported in part by the Sidney Kimmel Center for Prostate and Urologic Cancers at Memorial Sloan Kettering Cancer Center (MSK), Pin Down Bladder Cancer, the Michael and Zena Wiener Research and Therapeutics Program in Bladder Cancer, and a Cancer Center Support Grant (P30 CA008748) to MSK from the National Institutes of Health/National Cancer Institute.