Predictive Factors of Early Postoperative Complications After Robot-Assisted Radical Cystectomy for Urothelial Bladder Carcinoma

Purpose: To identify protective and risk factors of early postoperative complications after robot-assisted radical cystectomy (RARC) for urothelial bladder carcinoma. Methods: Data of all robot-assisted cystectomies performed in six French centers between February 2010 and December 2019 were retrospectively reviewed. All RARCs for bladder cancer (muscle-invasive and high-risk or Bacillus Calmette-Guerin-resistant nonmuscle-invasive bladder cancer) were included. Perioperative outcomes and early postoperative complications (in the first 30 days) were collected. Multivariable analysis was performed to identify factors associated with early postoperative complications. Results: Two hundred seventy patients were included. The overall incidence of early postoperative complications after RARC was 52.2% (27% of major complications). Most frequent complications were infectious complications (24.4%) and paralytic ileus (15.6%). Anticoagulant therapy (odds ratio [OR] = 2.909, 95% confidence interval [CI]: 1.003-8.432) and ureteroenteric anastomosis-type Wallace II (OR = 4.4, 95% CI: 1.435-13.489) were associated with a higher rate of overall complications. Complete intracorporeal diversion was a protective factor (OR = 0.399, 95% CI: 0.222-0.718). Tobacco consumption, anticoagulant therapy, and ureteroenteric anastomosis-type Wallace II were associated with a higher rate of minor complications (OR = 2.01, 95% CI: 1.079-3.744; OR = 2.495, 95% CI: 1.022-6.089; OR = 3.836, 95% CI: 1.384-10.63, respectively). Opioid-free analgesia (OFA) was associated with a lower rate of infectious complications (OR = 0.148, 95% CI: 0.034-0.644). Conclusion: Early postoperative complication rate after RARC for urothelial bladder carcinoma is high. Encouraging complete intracorporeal diversion and promoting OFA seem to reduce postoperative complications in the first 30 days. Prospective studies are needed to provide a high level of evidence.