Efficacy of the Addition of Robot-assisted Radical Cystectomy with Extracorporeal Urinary Diversion after an Enhanced Recovery Protocol

Abstract Background: Evaluation of the benefits to postoperative outcomes of introducing robot-assisted radical cystectomy (RARC) to enhanced recovery after surgery (ERAS) is limited, especially in RARC with extracorporeal urinary diversion (eRARC). We assessed whether eRARC, when added to ERAS, provided additional efficacy in terms of patient outcomes during its initial implementation. Methods: We retrospectively identified 143 patients undergoing radical cystectomy with urinary diversion between June 2010 and December 2021 at a single center. The patients were assigned to three groups based on the type of surgical procedures and perioperative recovery protocols used. Length of hospital stay (LOS) and 90-day postoperative complication rates were compared between the groups. Regression analyses were performed to evaluate how ERAS and eRARC affected outcomes. Whereas, multivariate analysis was used to detect LOS predictors. Results: The median LOS was shorter with ERAS and eRARC (28.0 vs. 20.0 vs. 17.0 days, P < 0.001). In the linear regression model, ERAS was associated with a significantly shorter LOS (10.4 days, P < 0.001); eRARC was also associated with a shorter LOS, but the difference was nonsignificant (4.10 days, P = 0.14). Neither ERAS nor eRARC was associated with a significant improvement in complications. Following multivariate analysis, ERAS was found to be independently associated with shorter LOS (OR 0.23, P < 0.001), but eRARC showed no such association (OR 0.29, P = 0.096). Conclusion: ERAS was significantly associated with shorter LOS. Although a desirable trend was evident, eRARC did not contribute to additional efficacy. Neither ERAS nor eRARC improved complications.