Atlas of Intracorporeal Orthotopic Neobladder Techniques After Robot-assisted Radical Cystectomy and Systematic Review of Clinical Outcomes.

BACKGROUND: Multiple and heterogeneous techniques have been described for orthotopic neobladder (ONB) reconstruction after robot-assisted radical cystectomy. Nonetheless, a systematic assessment of all the available options is lacking. OBJECTIVE: To provide the first comprehensive step-by-step description of all the available techniques for robotic intracorporeal ONB together with individual intraoperative, perioperative and functional outcomes based on a systematic review of the literature. DESIGN, SETTING, AND PARTICIPANTS: We performed a systematic review of the literature, and MEDLINE/PubMed, Embase, Scopus, and Web of Science databases were searched to identify original articles describing different robotic intracorporeal ONB techniques and reporting intra- and perioperative outcomes. Studies were categorized according to ONB type, providing a synthesis of the current evidence. Video material was provided by experts in the field to illustrate the surgical technique of each intracorporeal ONB. SURGICAL PROCEDURE: Nine different ONB types were identified: Studer, Hautmann, Y shape, U shape, Bordeaux, Pyramid, Shell, Florence Robotic Intracorporeal Neobladder, and Padua Ileal Neobladder. MEASUREMENTS: Continuous and categorical variables are presented as mean ± standard deviation and as frequencies and proportions, respectively. RESULTS AND LIMITATIONS: Of 2587 studies identified, 19 met our inclusion criteria. No cohort studies or randomized control trials comparing different neobladder types are available. Available techniques for intracorporeal robotic ONB reconstruction have similar operative time, estimated blood loss, intraoperative complications, and length of stay. Major variability exists concerning postoperative complications and functional outcomes, likely related to reporting bias. CONCLUSIONS: Several techniques are described for intracorporeal ONB during robot-assisted radical cystectomy with comparable perioperative outcomes. We provide the first step-by-step surgical atlas for robot-assisted ONB reconstruction. Further comparative studies are needed to assess any advantage of one technique over others. PATIENT SUMMARY: Patients elected for radical cystectomy should be aware that multiple techniques for robotic orthotopic neobladder are available, but that current evidence does not favor one type over the others.

A nomogram to predict pathologic T2 stage in candidates to robot-assisted radical prostatectomy with iT3 prostate cancer on preoperative multiparametric MRI: results from a multi-institutional collaboration.

In candidates to robot-assisted radical prostatectomy (RARP) for locally advanced (iT3) prostate cancer on preoperative MRI, the performance of MRI for local staging is demonstrably suboptimal, and currently no prediction tools that might help surgeons in preoperative planning are available. We analyzed data of 685 patients with iT3 prostate cancer (PCa) who received RARP at five participating institutions between 2012 and 2020. Multivariable logistic regression model investigated predictors of pT2 disease among variables available before surgery (i.e.: preoperative PSA, biopsy ISUP group, clinical T stage on digital rectal examination-DRE, prostate volume on MRI, PIRADS score of index lesion, seminal vesicles invasion on MRI, location suspicious for T3 disease on MRI). Coefficients from such model were used to build a nomogram to predict organ-confined (i.e. pT2) disease on final pathology. Internal validation was performed using the leave-one-out cross-validation. Median (interquartile range) preoperative PSA was 7.5 (5.2, 11.9) ng/mL, and 280 (41%) and 216 (32%) had biopsy ISUP group 4-5 disease and palpable disease on DRE, respectively. Preoperative MRI was suspicious for iT3 disease on the mid-posterior part of the gland in 485 (71%) men, and 527 (77%) men had a PIRADS 5 lesion. After surgery, a total of 192 (28%) patients had organ-confined disease (i.e. pT2). All variables fitted into the model and were considered to build the nomogram. After internal validation, the AUC was 73% (95% confidence interval: 69%, 77%). Awaiting external validation, we provided data that is relevant to optimize surgical strategy in men diagnosed with iT3 PCa who are scheduled for RARP.