Benefits of robotic cystectomy with intracorporeal diversion for patients with low cardiorespiratory fitness: a prospective cohort study

Lamb, B. W. et al. (2016) Benefits of robotic cystectomy with intracorporeal diversion for patients with low cardiorespiratory fitness: a prospective cohort study. Urologic Oncology: Seminars and Original Investigations, 34(9), 417.e17-417.e23. (doi: 10.1016/j.urolonc.2016.04.006) (PMID:27197920)

Abstract

Background: Patients undergoing radical cystectomy have associated comorbidities resulting in reduced cardiorespiratory fitness. Preoperative cardiopulmonary exercise testing (CPET) measures including anaerobic threshold (AT) can predict major adverse events (MAE) and hospital length of stay (LOS) for patients undergoing open and robotic cystectomy with extracorporeal diversion. Our objective was to determine the relationship between CPET measures and outcome in patients undergoing robotic radical cystectomy and intracorporeal diversion (intracorporeal robotic assisted radical cystectomy [iRARC]). Methods: A single institution prospective cohort study in patients undergoing iRARC for muscle invasive and high-grade bladder cancer. Inclusion: patients undergoing standardised CPET before iRARC. Exclusions: patients not consenting to data collection. Data on CPET measures (AT, ventilatory equivalent for carbon dioxide [VE/VCO2] at AT, peak oxygen uptake [VO2]), and patient demographics prospectively collected. Outcome measurements included hospital LOS; 30-day MAE and 90-day mortality data, which were prospectively recorded. Descriptive and regression analyses were used to assess whether CPET measures were associated with or predicted outcomes. Results: From June 2011 to March 2015, 128 patients underwent radical cystectomy (open cystectomy, n = 17; iRARC, n = 111). A total of 82 patients who underwent iRARC and CPET and consented to participation were included. Median (interquartile range): age = 65 (58–73); body mass index = 27 (23–30); AT = 10.0 (9–11), Peak VO2 = 15.0 (13–18.5), VE/VCO2 (AT) = 33.0 (30–38). 30-day MAE = 14/111 (12.6%): death = 2, multiorgan failure = 2, abscess = 2, gastrointestinal = 2, renal = 6; 90-day mortality = 3/111 (2.7%). AT, peak VO2, and VE/VCO2 (at AT) were not significant predictors of 30-day MAE or LOS. The results are limited by the absence of control group undergoing open surgery. Conclusions: Poor cardiorespiratory fitness does not predict increased hospital LOS or MAEs in patients undergoing iRARC. Overall, MAE and LOS comparable with other series.

• Item Type: Articles
• Additional Information: Funding and support were received from UCL Division of Surgery and Interventional Science, the National Institute for Health Research (NIHR) University College London Hospitals (UCLH) Biomedical Research Center, Imperial Patient Safety Translational Research Center, which is funded by the NIHR Biomedical Research Centre at UCLH, NHS Foundation Trust and University College London, United Kingdom.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Ahmad, Professor Imran
• Authors: Lamb, B. W., Tan, W. S., Eneje, P., Bruce, D., Jones, A., Ahmad, I., Sridhar, A., Baker, H., Briggs, T. P., Hines, J. E., Nathan, S., Martin, D., Stephens, R. C., and Kelly, J. D.
• College/School: College of Medical Veterinary and Life Sciences > School of Cancer Sciences
• Journal Name: Urologic Oncology: Seminars and Original Investigations
• Publisher: Elsevier
• ISSN: 1078-1439
• Published Online: 16 May 2016
• Copyright Holders: Copyright © 2016 Elsevier Inc.
• First Published: First published in Urologic Oncology: Seminars and Original Investigations 34(9): 417.e17-417.e23
• Publisher Policy: Reproduced in accordance with the publisher copyright policy