Long-term oncologic outcomes of robot-assisted radical cystectomy: Prognostic indicators and complication profiles from a high-volume single-surgeon series.

PURPOSE Robot-assisted radical cystectomy (RARC) is globally accepted, but single-surgeon, high-volume data linking perioperative factors with long-term oncologic outcomes are limited.

MATERIALS AND METHODS We retrospectively reviewed 304 consecutive RARC cases performed by one surgeon between 2007 and 2024. Total intracorporeal urinary diversion (ICUD) was used in 73.0% of patients and orthotopic neobladder (ONB) reconstruction in 64.5%. Median follow-up was 51.21 months. Primary endpoints were overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS). Secondary endpoints included complication profiles and pentafecta, defined as margin-negative resection, ≥16 or more lymph nodes, no Clavien-Dindo grade ≥3 or higher complication within 90 days, no recurrence within 12 months, and no ureteroenteric stricture.

RESULTS Mean operative time was 447.61 minutes, median lymph-node yield was 31.0 in the extended PLND group and 24.0 in the standard PLND group, and the positive margin rate was 1.0%. ICUD was associated with shorter hospitalization than extracorporeal diversion (13.81 days vs. 17.03 days, p=0.026) and fewer early high-grade complications. Seven-year OS, CSS, and RFS were higher in pentafecta achievers (69.3%, 94.2%, and 82.6%), and 7-year OS was also superior in patients with organ-confined (≤T2) and node-negative disease (69.0% vs. 28.6% and 67.5% vs. 19.4%). Complications occurred in 59.7% overall, with 14.9% major; infections were most common (20.7%).

CONCLUSIONS In a high-volume single-surgeon series, RARC with ICUD provided durable oncologic control, acceptable morbidity, and high pentafecta achievement. Pathologic T and N stage and pentafecta were significant prognostic indicators that may assist in refining patient selection, guiding postoperative surveillance, and informing survivorship care.