Abstract: PD67-12
Sources of Funding: none

Introduction

Open surgery for removing the bladder and/or prostate after radiation therapy is a challenging procedure with a high complication rate. We wanted to assess the feasibility and complication rates in similar cases utilizing robotic surgery.

Methods

We identified 13 patients undergoing robotic surgery after radiation therapy in our robotic surgery database. Ten underwent a cystectomy and 3 radical salvage prostatectomy. We collected demographic, surgery and post-surgery data during their hospital stay.

Results

In the cystectomy group there were 6 females and 4 males, mean age 68 years. Three of the patients were 81, 84 and 85 years old. Two female patients had prior brachytherapy due to cervical cancer and developed a small contracted bladder with vesico-vaginal fistula. Two males with external beam radiation and one male with brachytherapy for prostate cancer developed TCC. One male with squamous cell carcinoma and 4 others with TCC that received chemo-radiation in the past, were sent to salvage cystectomy due to local recurrence. Five patients received neoadjuvant chemotherapy prior to surgery._x000D_ Mean operating time was 6:53 hours. Mean operative blood loss 461 ml. Three patients received 2 units of packed cells apiece during surgery due to blood loss of 800 ml each. The mean blood loss for the others was 291 ml._x000D_ One female patient with prior multiple open abdominal surgeries had adhesions that required conversion to open surgery which ended with bowel injury and cystectomy was aborted. Post-operative complications consisted of transient ileus in 3 patients. Mean hospital stay was 6 days (range 4-8 days). Six patients were discharged with a drain due to increased serous drainage, which was later removed in our clinic. In the radical prostatectomy group mean operative time was 2:46 hours, mean blood loss was 133 ml, there were no intra-operative or post-operative complications. Mean hospital stay was 5 days (range 3-8 days).

Conclusions

Robotic cystectomy and/or prostatectomy after radiation therapy to the pelvis is an effective and safe procedure. Nonetheless, it has the risk of increased blood loss during surgery, increased hospital stay and more serous secretions through the drains compared to robotic surgery in patients without prior radiation therapy.

Funding

none