Introduction: The objective of this study was to evaluate the impact of cumulative smoking exposure (pack/year) and of time since smoking cessation (>1 year) on perioperative morbidity after robot-assisted radical cystectomy (RARC) for muscle invasive bladder cancer (MIBC). Methods: We retrospectively evaluated 328 patients treated with RARC for MIBC at OLV hospital (Aalst, Belgium) between 2015 and 2020. All procedures were performed by two highly experienced robotic surgeons. Perioperative morbidity was defined as any post-operative early ( <90 days) complications and/or post-operative readmission. Multivariable logistic regressions were performed to explore the effect of smoking status (current vs. former vs. never smoker), cumulative smoking exposure (in pack-years, calculated by multiplying the number of years smoked with the average number of packs per day) and time since smoking cessation on perioperative morbidity after RARC. Results: Overall, 133 (40%), 132 (40%) and 63 (20%) patients were never, former and current smokers respectively. Median age was 71 years (interquartile range [IQR]: 62, 78). No differences were recorded in terms of age, gender, and cT and cN stage (all p>0.05). No significant differences were recorded in terms of urinary diversion (UD, neobladder vs ileal conduit) or UD approach (extra-corporeal vs intra-corporeal). Current smokers had significantly longer smoking duration (43 vs. 30 years; p<0.001) and higher cumulative smoking exposure (35 vs. 30 pack/year; p=0.02) when compared with former smokers. Median time since smoking cessation for former smokers was 15 years (IQR: 8, 27). Overall, 69 (21%) patients were readmitted to the hospital without differences among the three groups. 38 current smokers (60%), 66 former smokers (50%) and 49 never smokers (37%) experienced early post-operative complications (p=0.005). 13 (24%) current smokers, 25 (17%) former smokers and 18 (13%) never smokers experienced more than one early complication. On multivariable analysis, former (odds ratio [OR]: 3.8; 95% confidence interval [CI]: 1.7, 9.3; p=0.002) and current (OR: 6.7; 95%CI: 2.8, 12; p<0.001) smokers had higher odds of perioperative morbidity as compared to patients who never smoked. Conclusions: Smoking status, time since smoking cessation and cumulative smoking exposure are significantly associated with perioperative morbidity after RARC. Further studies with longer follow-up are awaited to confirm these findings. SOURCE OF Funding: None
