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BACKGROUND: Robotic-assisted radical cystectomy with extended pelvic lymph node dissection(RARC) has been proposed to be less morbid than open RC with similar oncologic outcomes. We present the complication rates and survival outcomes of patients undergoing RARC for bladder cancer at our institution.
METHODS: Patients undergoing RARC 04/2004-10/2012 were reviewed from our database(IRB-approved). Patient demographics, clinical stage, pathologic stage, and perioperative complications were analyzed utilizing Chi Square/Fisher’s Exact test. Overall survival(OS) and disease-specific(DSS) survival were estimated utilizing the Kaplan-Meier method. Cox-Proportional regression analysis was employed to evaluate associations between potential risk factors and outcomes.
RESULTS: 103 patients met inclusion; demographics and tumor stage distribution is listed in table 1. Median follow-up was 23 months(1-92). 2 and 4 year OS was 74%/58%, and DSS was 80%/65%, respectively. Patients with≤pT2 tumors demonstrated 2 and 4 year OS rates of 92%/82%, vs. 48%/31.6% for patients with≥pT3a tumors. In Cox-regression analysis, ≥pT2(p<0.01; HR 4.7), lymph node involvement(p<0.01; HR:4), PSM(p=0.04; HR 3.2), and perioperative complications(p<0.01; HR 1.28) were significantly associated with decreased OS. Age, gender, BMI, ASA score and neoadjuvant chemotherapy were not significantly predictive of survival.
CONCLUSIONS: Outcomes and complications rates of RARC were comparable with those of open RC series. Neoadjuvant chemotherapy did not influence survival, but a larger cohort size may be required for accurate analysis . Further follow up is needed to definitively assess equivalence of RARC.

Table 1: Patient demographics and tumor stage distribution.

Demographics
Age, mean (range, years) Gender (Female/Male)	67.2+/-10 (40-89) 18/85
ASA Score, mean BMI, mean (kg/m2)	2.6+/-0.8 28
Neoadjuvant Chemotherapy, (%) Diversion Type (%) Conduit/continent pouch	26 (25.2) 69(67.7)/34(32.3)
Lymph Node Involvement (%)Positive Surgical Margin (%)	20 (19.4)8 (7.7)
Perioperative Complications (%) Clavien Grade ≥3	70 (68)30 (29)
	T0 Tcis-Ta-T1 T2 T3 T4
Clinical StagepT-TUR	N/A 29 53 14 6 N/A 39 59 0 2
pT-RCPFinal Pathology	18 26 24 24 10N/A 29 35 26 12