Introduction: We aim to present oncologic, functional, and complications outcomes for patients undergoing Robot-assisted radical cystectomy (RARC) from a large multi-institutional cystectomy cohort. Methods: Data from patients who underwent RARC with intracorporeal neobladder diversion between 2003-2022 from our multi-national, multi-institutional cohort were prospectively collected. Baseline demographic and clinical characteristics as well as oncologic, complications and functional outcomes were analyzed. Survival rates were estimated with Kaplan-Meier plots. Results: Of 359 patients, 319 (88.9%) were male. Mean (SD) age was 62.8 (9.4) and BMI was 26.8 (4.2). The cohort included 33 (9.2%) pTa or pTis, 104 (29.1%) pT1, 185 (51.8%) pT2, 31 (8.7%) pT3, and 4 (1.1%) pT4 bladder tumors preoperatively. Median [IQR] follow-up time was 17.6 mo [9.3, 38.5]. We recorded positive margins in 4 (1.1%) patients. Clavien 3-5 complications occurred in 59 (16.4%) and 96 (27.3%) patients within 30 and 90 days, respectively. Clavien <3 complications occurred in 130 (35.2%) and 199 (55.4%) patients within 30 and 90 days, respectively. Kaplan-Meier estimates for recurrence free, cancer-specific, and overall survival at 24 mo were 76.7%, 87.6%, and 86.2% respectively. Percentage of patients requiring 0, 1, or >1 pad for daytime continence at 12 mo was 72.4%, 9.6%, and 18% respectively for men, and 38.1%, 9.5%, and 52.4% respectively for women. Percentage of patients requiring 0, 1, or >1 pad for nighttime continence at 12 mo was 24.5%, 34.2%, and 41.3% respectively for men and 25%, 35%, and 40% respectively for women. The percentage of patients requiring 0-1 pads for daytime and nighttime continence at 12 mo was 82.9% and 60.2%, respectively with nerve sparing, compared to 72.7% and 40.9%, respectively without nerve sparing. When nerve sparing technique was utilized, potency at 12 mo without assistance and with a PDE-5 inhibitor was 41.2% and 75.4%, respectively. Conclusions: We report outcomes for RARC with intracorporeal neobladder diversion from a multi-institutional cohort. Importantly, oncologic, complications, and functional outcomes appear non-inferior to prior open series, with improvements in functional outcomes using nerve-sparing technique. SOURCE OF Funding: None
