Presented by: Sij Hemal MD
University of Southern California - USC Institute of Urology

Introduction

Previous abdominal surgery (PAS) is considered a relative contraindication to subsequent complex robotic oncologic urologic surgery such as RRC-ICUD. We compared outcomes of patients undergoing RRC-ICUD with a history of PAS vs those without PAS.

Materials

From 07/2010 to 12/2021, 445 consecutive patients underwent RRC-ICUD. Patients were divided into no PAS vs PAS, the latter further sub-stratified into 1 PAS and ≥2 PAS. Outcomes of interest were operative time (OT), overall 30-day complication rate, readmission rate and presence of genitourinary (GU) complications. Multivariate analysis assessed the impact of PAS on the outcome of interest controlled by clinical stage, gender, urinary diversion type and BMI (p<0.05 significance level). Cox-regression was performed for overall survival (OS) and recurrence free survival (RFS).

Results

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Of 445 patients undergoing RRC-ICUD, 266 had no history of (h/o) PAS and 179 had h/o PAS. No significant differences were noted in Operative Time (OT), Estimated Blood Loss (EBL), hospital stay, early complications (cardiac, gastrointestinal, GU, DVT, infection, neuro). Significant differences were observed in early post-op transfusion rate (20 vs 30%, p=0.02). No significant differences were observed in overall complications at 30 and 90 days. Higher 30-day readmission rate was noted for the PAS group (18 vs 26%, p=0.03). Positive surgical margin rates were similar. On multivariate analysis, h/o PAS and increasing number of PAS (0 vs 1; 0 vs ≥2; 1 vs ≥2) were independent predictors for readmission and 30-day GU complications. On comparing number of PAS, PAS ≥ 2 was an independent predictor for a higher 30- day readmission % (RR 2.4, p=0.01) and GU complication rate (RR 1.8, p=0.01). BMI independently predicted longer OT (est. 0.03, p=0.03), higher readmission rate (RR 1.06, p=0.01), and increased overall 30-day complication rate (RR 1.04, p=0.03). No differences were found for the OS (p=0.29, p=0.68) and RFS (p=0.82, p=0.6).

Conclusion

RRC-ICUD is a feasible procedure in patients with a history of prior abdominal surgery, yielding similar overall complication rates, surgical margin rates, and survival to those with no PAS. However, patients with PAS should be counseled on a slightly greater risk of readmission and need for perioperative transfusion.

Funding

No sources of funding were utilized. This was an IRB approved study. 

Lead Authors

Michael Eppler, MD
University of Southern California - USC Institute of Urology

Co-Authors

Aref Sayegh, MD
University of Southern California - USC Institute of Urology

Monish Aron, MD, MBA, FACS
University of Southern California - USC Institute of Urology

Mihir Desai, MD
University of Southern California - USC Institute of Urology

Inderbir Gill, MD
University of Southern California - USC Institute of Urology

Giovanni Cacciamani, MD
University of Southern California - USC Institute of Urology