Radical Cystectomy with Elective Indication to Cutaneous Ureterostomy: Single-Center Comparative Analysis Between Open and Robotic Surgery in Frail Patients.

Objectives: Radical cystectomy (RC) is a surgical procedure associated with high rates of morbidity. The aim of the study is to provide a comparison between robotic (RARC) and open RC (ORC) in patients elected to cutaneous ureterostomy (CUS).

Materials and methods: This is a retrospective single-center cohort study performed at a high-volume institution. The study involved 64 patients undergoing RC with CUS, 42 ORC and 22 RARC. The indication for RC was based on EAU guidelines and the choice of CUS was planned due to advanced oncological stage or patient's frailty. Patient allocation to the robotic or open approach for RC was casual, determined by surgeon preference and/or the availability of a robotic operating room. The Adverse events were systematically graded utilizing the Clavien-Dindo classification system.

Results: Complications of Clavien Dindo ≥ 2 occurred in 27 out of 42 (64.2%) ORC and 3/22 (13.6%) RARC (p < 0.001); complications of Clavien Dindo ≥ 3 occurred in 10/42 (23.8%) ORC and only 1/22 (4.5%) RARC, respectively (p = 0.08). Multivariable analysis revealed that robotic surgery was the only variable inversely associated with Clavien Dindo ≤ 2 complications.

Conclusions: In conclusion, RARC appears to be associated with lower morbidity and reduced incidence of complications, elements that make it particularly suitable for frail patients with an elective indication for CUS.