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PD39-03 COMPLICATIONS AFTER TOTALLY INTRACORPOREAL ROBOT-ASSISTED RADICAL CYSTECTOMY: RESULTS FROM THE EUROPEAN ASSOCIATION OF UROLOGY ROBOTIC UROLOGY SECTION (ERUS) SCIENTIFIC WORKING GROUP.
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Vol. 195, No. 4S, Supplement, Monday, May 9, 2016
Bladder Cancer: Invasive VI Podium Monday, May 9, 2016
10:30 AM-12:30 PM
PD39-01 PROPHYLACTIC USE OF AN INTRAPERITONEAL ONLAY MESH DURING ILEAL CONDUIT URINARY DIVERSION FOR THE PREVENTION OF PARASTOMAL HERNIAS. INITIAL EXPERIENCE Itay Sternberg*, Daniel Yaffe, Amir Akdam, Ilan Leibovitch, Kfar Saba, Israel INTRODUCTION AND OBJECTIVES: Parastomal hernias develop in a quarter of patients within one year after cystectomy and ileal conduit urinary diversion (RC/IC) and half of patients within 2 years. Prophylactic placement of mesh during surgery has been described in colorectal surgery to be safe and effective. METHODS: Since October 2013, 20 consecutive patients underwent prophylactic placement of DynaMesh IPSTâ during RC/IC at our institution. The last 30 consecutive patients treated with RC/IC prior to October 2013 were used as the control group. We compared patient characteristics, operative times and 90-day postoperative complications between the groups. Continuous variables were compared using the Mann-Whitney test and dichotomous variables were compared using Fisher’s exact test. RESULTS: Patient characteristics were similar between the groups. Seven of 20 patients in the DynaMesh group and 7 of 30 in the control group had additional procedures done at the time of RC/IC. Median operative times in patients without additional procedures were 301 minutes (IQR 229-474) and 283 (IQR 246-336) in the DynaMesh and control groups, respectively. This difference was not statistically significant (p¼0.06). Major complications occurred in 6 of 20 (30%) and 10 of 30 (33%) of patients in the DynaMesh and control groups, respectively. Minor complications were recorded in 10 of 20 (50%) and 16 of 30 (53%) patients in the DynaMesh and control groups, respectively. Both these differences, in major and minor complications, were not statistically significant (p¼0.77 and 0.78, respectively). None of the major complications were related to the placement of the mesh. With a median follow up of 13.5 months none of the patients needed removal of the mesh and none developed PSH. CONCLUSIONS: Our initial experience suggests that prophylactic placement of mesh during RC/IC for parastomal hernia prevention is effective, safe and does not elongate surgery considerably. A larger trial is needed to validate our results. Source of Funding: none
PD39-02 EARLY OUTCOMES OF PROPHYLACTIC MESH PLACEMENT AT RADICAL CYSTECTOMY TO PREVENT PARASTOMAL HERNIAS Timothy F. Donahue*, Eugene K. Cha, Cristina Falavolti, Simon Y. Kimm, Hebert Alberto Vargas, Guido Dalbagni, Bernard H. Bochner, New York, NY INTRODUCTION AND OBJECTIVES: Parastomal hernia (PH) is a frequent complication of ileal conduit (IC) construction that can negatively impact quality of life. Placement of mesh at the time of IC may reduce the incidence of PH. We describe the early complications and outcomes of prophylactic mesh placement at the time of IC following radical cystectomy. METHODS: Beginning September 2013, we altered our practice to offer prophylactic mesh in patients at high-risk for PH development (female gender and males with BMI > 30). Partially-absorbable mesh was placed dorsal to the rectus muscle and anterior to the
posterior rectus sheath circumferentially around the conduit. Early complications were recorded and radiographic PH (rPH) rates for patients receiving mesh were compared to a historic cohort of 220 highrisk patients. RESULTS: The median follow-up for 33 patients having prophylactic mesh placed was 479 days, 66% of whom had > 1 year follow-up. The median age of 16 men and 17 women was 71.1 years with a median BMI of 31.3. Wound and infectious complications physically remote from the mesh were the most commonly seen (pelvic abscess¼5; enterocutaneous fistula¼1; superficial wound infection or seroma¼12) and all were managed successfully with percutaneous drainage and local wound care. There were no mesh infections, fistulas, or strictures identified and no patient required removal of mesh during the study period. At 1 year, 4 of 33 prophylactic mesh patients (12%) had rPH, compared to 59 of 220 (27%) of historic controls, representing a 56% relative risk reduction (p¼0.043). Of the 6 of 33 mesh patients who developed rPH, only 2 were clinically apparent over the short period of follow-up. CONCLUSIONS: Placement of prophylactic mesh in patients at high-risk for PH appears feasible and safe. Wound-related complications separate from the mesh were successfully managed with drainage and local wound care. Over a short period of follow up, the radiographic PH rate appears lowered by prophylactic mesh placement at IC. Source of Funding: None
PD39-03 COMPLICATIONS AFTER TOTALLY INTRACORPOREAL ROBOTASSISTED RADICAL CYSTECTOMY: RESULTS FROM THE EUROPEAN ASSOCIATION OF UROLOGY ROBOTIC UROLOGY SECTION (ERUS) SCIENTIFIC WORKING GROUP. Abolfazl Hosseini*, Justin Collins, Christofer Adding, Tommy Nyberg, Stockholm, Sweden; Anthony Koupparis, Edward Rowe, Bristol, United Kingdom; Matthew Perry, Rami Issa, London, United Kingdom; Martin Schumacher, Aarau, Switzerland; Carl Wijburg, Arnham, Netherlands; Erdem Canda, Ankara, Turkey; Mevlana Balbay, Istanbul, Turkey; Karel Decaestecker, Ghent, Belgium; Christian Schwentner, Arnulf Stenzl, Tubingen, Germany; Sebastian Edeling, Sasa Pokupic, Hanover, Germany; Khurshid Guru, Buffalo, NY; Alexander Mottrie, Aalst, Belgium; Peter Wiklund, Stockholm, Sweden INTRODUCTION AND OBJECTIVES: Radical cystectomy is associated with high complications rates irrespective of surgical approach. Worldwide most centers performing robotic-assisted radical cystectomy (RARC) perform an extracorporeal urinary diversion, despite potential advantages of a completely minimally invasive technique. A commonly held perception is that a totally intracorporeal approach is more complex and risks higher rates of complications. We describe complication outcomes after totally intracorporeal RARC from a multi-institutional database using a standardized and validated reporting methodology. METHODS: Within the database we identified 621 patients who underwent totally intracorporeal RARC with at least 90d of follow-up. Complications were analyzed and graded according to the Clavien Dindo Classification system and were further stratified by organ system. Further classification included early (<30d) and late (30-90days) complication rates. Secondary outcomes included identification of preop and intra-operative variables associated with complications. Logistic regression models were used to define predictors of complications and readmission, using backward selection (p<0.05). RESULTS: Overall 55% (n¼343) of patients experienced a complication within 90d of their operation, 49% (n¼306) and 17% (n¼103) within 30d and 30-90d of surgery respectively. 32% of patients (n¼197) experienced low grade complications (Clavien grade 1-2) and 23.5% (n¼146) experienced high grade complications (Clavien grade ¼3). Thirty and 90day mortality was 0.6% and 1.9%, respectively. Overall 30d readmission rate was 25%. Complications were also classified according to body system effected. Infectious, gastrointestinal and genitourinary complications were most common (41%, 19%, and
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15%, respectively). On multivariable analysis of 0-90d complications we found neobladder diversion and ASA grade to be predictors of any grade complications. As a multi-institutional database, disparities in patient selection and postoperative management are potential limitations of the study. CONCLUSIONS: Surgical morbidity after totally intracorporeal RARC is significant when reported using standardized reporting methods. The majority of complications are low grade. Neobladder diversion and increased ASA grade increase the risk of any grade complication. Accurate reporting of complications is necessary to clarify optimum approaches to radical cystectomy and to guide patient counselling. Source of Funding: None
PD39-04 TIMING OF BLOOD TRANSFUSION AND NOT ABO BLOOD TYPE IS ASSOCIATED WITH SURVIVAL IN PATIENTS TREATED WITH RADICAL CYSTECTOMY FOR NON-METASTATIC BLADDER CANCER: RESULTS FROM A SINGLE HIGH-VOLUME INSTITUTION Marco Moschini*, Giorgio Gandaglia, Vito Cucchiara, Giusy Burgio, Milan, Italy; Agostino Mattei, Lucerne, Switzerland; Shahrokh Francois Shariat, Vienna, Austria; Francesco Cantiello, Rocco Damiano, Catanzaro, Italy; Andrea Salonia, Alberto Briganti, Francesco Montorsi, Renzo Colombo, Andrea Gallina, Milan, Italy INTRODUCTION AND OBJECTIVES: Recently, several biochemical or hematological parameters have been described as possible predictors of survival in BCa patients treated with RC. Specifically, perioperative transfusions have been recently associated to poor outcomes as an indirect consequence of immune-hematological changes related to transfusion itself and blood type. We tested the role of blood transfusion on cancer specific mortality (CSM) and overall mortality (OM), considering the impact of ABO system, RH factor and timing of transfusions METHODS: The study focused on 728 BCa patients treated with RC at a single tertiary care referral center between January 1995 and August 2013 with complete ABO blood type information. KaplanMeier was used to assess the effect of transfusions, stratified according to ABO type and Rh status, on CSM and OM. The same endpoints were tested in Cox regression models, after adjusting for year of surgery, age, gender, Charlson comorbidity index, intra- and post-op transfusions, Rh status, pre-op anemia, number of nodes removed, pathological T and N stage, surgical margins and adjuvant chemotherapy RESULTS: A total of 341 (46.8%), 277 (38.0%), 83 (11.4%) and 27 (3.7%) patients had blood type O, A, B and AB, respectively. Overall, 630 (86.5%) and 98 (13.5%) were Rh- and Rh+, respectively. At a median follow-up time of 65 months, 225 (30.9%) and 282 (38.7%) patients recorded CSM and OM, respectively. At univariable analyses, ABO blood type and Rh status were not associated to either CSM or OM (all p>0.2). Similar results were observed when ABO blood type and Rh status were tested in multivariable models (all p>0.3). Conversely, Charlson score, age, number of nodes removed, pathological T stage, pathological N stage, anemia status, and surgical margin status were associated to both CSM and OM (all p<0.05). Interestingly, intraop transfusion (all p <0.045) but not the administration of blood units in the post-op period (p>0.4) were associated with an increase of CSM and OM CONCLUSIONS: Although ABO type and/or Rh factor were associated with several adverse outcomes in many cancers, we were not able to confirm this association in BCa. Based on our results, the impact of transfusion on survival is independent by ABO type but is associated to the timing of blood supply administration. It may be argued that intra-operative transfusion may represent a proxy for more complex surgery and, in turn, for more advanced disease which may translate into a reduction of survival after surgery Source of Funding: none
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PD39-05 ONCOLOGICAL OUTCOMES OF TOTALLY INTRACORPOREAL ROBOT-ASSISTED RADICAL CYSTECTOMY: RESULTS FROM THE EUROPEAN ASSOCIATION OF UROLOGY ROBOTIC UROLOGY SECTION (ERUS) SCIENTIFIC WORKING GROUP Abolfazl Hosseini*, Justin Collins, Christofer Adding, Tommy Nyberg, Stockholm, Sweden; Anthony Koupparis, Edward Rowe, Bristol, United Kingdom; Matthew Perry, Rami Issa, London, United Kingdom; Martin Schumacher, Aarau, Switzerland; Carl Wijburg, Arnham, Netherlands; Erdem Canda, Ankara, Turkey; Mevlana Balbay, Istanbul, Turkey; Karel Decaestecker, Ghent, Belgium; Christian Schwentner, Arnulf Stenzl, Tubingen, Germany; Sebastian Edeling, Sasa Pokupic, Hanover, Germany; Khurshid Guru, Buffalo, NY; Alexander Mottrie, Aalst, Belgium; Peter Wiklund, Stockholm, Sweden INTRODUCTION AND OBJECTIVES: Data on the oncological outcomes in patients undergoing robot-assisted radical cystectomy (RARC) is limited. Globally extracorporeal urinary diversion following RARC remains the most common approach despite potential advantages of a completely minimally invasive approach. We report oncological outcomes and associated prognostic factors from a multiinstitutional European database focusing on the centres performing totally intracorporeal RARC. METHODS: Retrospective review of the prospectively populated ERUS scientific working group multi-institutional database identified 621 patients at 10 different Institutions (7 countries), with a minimum of 3 months follow-up, who underwent RARC with an intracorporeal urinary diversion between December 2003 and January 2015. Clinical, pathologic, and survival data at the latest follow-up were collected. RESULTS: Median age was 66 years, 83% were men. 95% of patients had transitional cell carcinoma. 112 (76%) patients were alive at the time of the analysis. 24% received neoadjuvant chemotherapy. The median follow-up time for patients was 19 months (IQR 11-36). 147 patients had a minimum of 3 years follow-up and 47 patients (32%) had undergone surgery 5 or more years ago. 30 patients (4.85%) had a positive surgical margin (PSM), of which 28 (93.3%) had T3/T4 disease, equivalent to 13.9% of all patients with T3/T4. Two patients (0.7%) with organ-confined disease had a PSM. The median yield for extended pelvic lymph node dissection was 18. The 5-year cancer specific survival (CSS), overall survival (OS) and recurrence free survival (RFS) were 73.8%, 70.5% and 71.6% respectively. On multivariable analysis, non-organ confined versus organ confined disease was found to impact CSS, OS and RFS (HR 4.5, 3.3 and 4.2 respectively). In this series no patient with pT0 has had a recurrence to date. CONCLUSIONS: Medium term follow-up for totally intracorporeal RARC shows acceptable survival outcomes comparable to open radical cystectomy series.
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Vol. 195, No. 4S, Supplement, Monday, May 9, 2016
Bladder Cancer: Invasive VI Podium Monday, May 9, 2016
10:30 AM-12:30 PM
PD39-01 PROPHYLACTIC USE OF AN INTRAPERITONEAL ONLAY MESH DURING ILEAL CONDUIT URINARY DIVERSION FOR THE PREVENTION OF PARASTOMAL HERNIAS. INITIAL EXPERIENCE Itay Sternberg*, Daniel Yaffe, Amir Akdam, Ilan Leibovitch, Kfar Saba, Israel INTRODUCTION AND OBJECTIVES: Parastomal hernias develop in a quarter of patients within one year after cystectomy and ileal conduit urinary diversion (RC/IC) and half of patients within 2 years. Prophylactic placement of mesh during surgery has been described in colorectal surgery to be safe and effective. METHODS: Since October 2013, 20 consecutive patients underwent prophylactic placement of DynaMesh IPSTâ during RC/IC at our institution. The last 30 consecutive patients treated with RC/IC prior to October 2013 were used as the control group. We compared patient characteristics, operative times and 90-day postoperative complications between the groups. Continuous variables were compared using the Mann-Whitney test and dichotomous variables were compared using Fisher’s exact test. RESULTS: Patient characteristics were similar between the groups. Seven of 20 patients in the DynaMesh group and 7 of 30 in the control group had additional procedures done at the time of RC/IC. Median operative times in patients without additional procedures were 301 minutes (IQR 229-474) and 283 (IQR 246-336) in the DynaMesh and control groups, respectively. This difference was not statistically significant (p¼0.06). Major complications occurred in 6 of 20 (30%) and 10 of 30 (33%) of patients in the DynaMesh and control groups, respectively. Minor complications were recorded in 10 of 20 (50%) and 16 of 30 (53%) patients in the DynaMesh and control groups, respectively. Both these differences, in major and minor complications, were not statistically significant (p¼0.77 and 0.78, respectively). None of the major complications were related to the placement of the mesh. With a median follow up of 13.5 months none of the patients needed removal of the mesh and none developed PSH. CONCLUSIONS: Our initial experience suggests that prophylactic placement of mesh during RC/IC for parastomal hernia prevention is effective, safe and does not elongate surgery considerably. A larger trial is needed to validate our results. Source of Funding: none
PD39-02 EARLY OUTCOMES OF PROPHYLACTIC MESH PLACEMENT AT RADICAL CYSTECTOMY TO PREVENT PARASTOMAL HERNIAS Timothy F. Donahue*, Eugene K. Cha, Cristina Falavolti, Simon Y. Kimm, Hebert Alberto Vargas, Guido Dalbagni, Bernard H. Bochner, New York, NY INTRODUCTION AND OBJECTIVES: Parastomal hernia (PH) is a frequent complication of ileal conduit (IC) construction that can negatively impact quality of life. Placement of mesh at the time of IC may reduce the incidence of PH. We describe the early complications and outcomes of prophylactic mesh placement at the time of IC following radical cystectomy. METHODS: Beginning September 2013, we altered our practice to offer prophylactic mesh in patients at high-risk for PH development (female gender and males with BMI > 30). Partially-absorbable mesh was placed dorsal to the rectus muscle and anterior to the
posterior rectus sheath circumferentially around the conduit. Early complications were recorded and radiographic PH (rPH) rates for patients receiving mesh were compared to a historic cohort of 220 highrisk patients. RESULTS: The median follow-up for 33 patients having prophylactic mesh placed was 479 days, 66% of whom had > 1 year follow-up. The median age of 16 men and 17 women was 71.1 years with a median BMI of 31.3. Wound and infectious complications physically remote from the mesh were the most commonly seen (pelvic abscess¼5; enterocutaneous fistula¼1; superficial wound infection or seroma¼12) and all were managed successfully with percutaneous drainage and local wound care. There were no mesh infections, fistulas, or strictures identified and no patient required removal of mesh during the study period. At 1 year, 4 of 33 prophylactic mesh patients (12%) had rPH, compared to 59 of 220 (27%) of historic controls, representing a 56% relative risk reduction (p¼0.043). Of the 6 of 33 mesh patients who developed rPH, only 2 were clinically apparent over the short period of follow-up. CONCLUSIONS: Placement of prophylactic mesh in patients at high-risk for PH appears feasible and safe. Wound-related complications separate from the mesh were successfully managed with drainage and local wound care. Over a short period of follow up, the radiographic PH rate appears lowered by prophylactic mesh placement at IC. Source of Funding: None
PD39-03 COMPLICATIONS AFTER TOTALLY INTRACORPOREAL ROBOTASSISTED RADICAL CYSTECTOMY: RESULTS FROM THE EUROPEAN ASSOCIATION OF UROLOGY ROBOTIC UROLOGY SECTION (ERUS) SCIENTIFIC WORKING GROUP. Abolfazl Hosseini*, Justin Collins, Christofer Adding, Tommy Nyberg, Stockholm, Sweden; Anthony Koupparis, Edward Rowe, Bristol, United Kingdom; Matthew Perry, Rami Issa, London, United Kingdom; Martin Schumacher, Aarau, Switzerland; Carl Wijburg, Arnham, Netherlands; Erdem Canda, Ankara, Turkey; Mevlana Balbay, Istanbul, Turkey; Karel Decaestecker, Ghent, Belgium; Christian Schwentner, Arnulf Stenzl, Tubingen, Germany; Sebastian Edeling, Sasa Pokupic, Hanover, Germany; Khurshid Guru, Buffalo, NY; Alexander Mottrie, Aalst, Belgium; Peter Wiklund, Stockholm, Sweden INTRODUCTION AND OBJECTIVES: Radical cystectomy is associated with high complications rates irrespective of surgical approach. Worldwide most centers performing robotic-assisted radical cystectomy (RARC) perform an extracorporeal urinary diversion, despite potential advantages of a completely minimally invasive technique. A commonly held perception is that a totally intracorporeal approach is more complex and risks higher rates of complications. We describe complication outcomes after totally intracorporeal RARC from a multi-institutional database using a standardized and validated reporting methodology. METHODS: Within the database we identified 621 patients who underwent totally intracorporeal RARC with at least 90d of follow-up. Complications were analyzed and graded according to the Clavien Dindo Classification system and were further stratified by organ system. Further classification included early (<30d) and late (30-90days) complication rates. Secondary outcomes included identification of preop and intra-operative variables associated with complications. Logistic regression models were used to define predictors of complications and readmission, using backward selection (p<0.05). RESULTS: Overall 55% (n¼343) of patients experienced a complication within 90d of their operation, 49% (n¼306) and 17% (n¼103) within 30d and 30-90d of surgery respectively. 32% of patients (n¼197) experienced low grade complications (Clavien grade 1-2) and 23.5% (n¼146) experienced high grade complications (Clavien grade ¼3). Thirty and 90day mortality was 0.6% and 1.9%, respectively. Overall 30d readmission rate was 25%. Complications were also classified according to body system effected. Infectious, gastrointestinal and genitourinary complications were most common (41%, 19%, and
THE JOURNAL OF UROLOGYâ
Vol. 195, No. 4S, Supplement, Monday, May 9, 2016
15%, respectively). On multivariable analysis of 0-90d complications we found neobladder diversion and ASA grade to be predictors of any grade complications. As a multi-institutional database, disparities in patient selection and postoperative management are potential limitations of the study. CONCLUSIONS: Surgical morbidity after totally intracorporeal RARC is significant when reported using standardized reporting methods. The majority of complications are low grade. Neobladder diversion and increased ASA grade increase the risk of any grade complication. Accurate reporting of complications is necessary to clarify optimum approaches to radical cystectomy and to guide patient counselling. Source of Funding: None
PD39-04 TIMING OF BLOOD TRANSFUSION AND NOT ABO BLOOD TYPE IS ASSOCIATED WITH SURVIVAL IN PATIENTS TREATED WITH RADICAL CYSTECTOMY FOR NON-METASTATIC BLADDER CANCER: RESULTS FROM A SINGLE HIGH-VOLUME INSTITUTION Marco Moschini*, Giorgio Gandaglia, Vito Cucchiara, Giusy Burgio, Milan, Italy; Agostino Mattei, Lucerne, Switzerland; Shahrokh Francois Shariat, Vienna, Austria; Francesco Cantiello, Rocco Damiano, Catanzaro, Italy; Andrea Salonia, Alberto Briganti, Francesco Montorsi, Renzo Colombo, Andrea Gallina, Milan, Italy INTRODUCTION AND OBJECTIVES: Recently, several biochemical or hematological parameters have been described as possible predictors of survival in BCa patients treated with RC. Specifically, perioperative transfusions have been recently associated to poor outcomes as an indirect consequence of immune-hematological changes related to transfusion itself and blood type. We tested the role of blood transfusion on cancer specific mortality (CSM) and overall mortality (OM), considering the impact of ABO system, RH factor and timing of transfusions METHODS: The study focused on 728 BCa patients treated with RC at a single tertiary care referral center between January 1995 and August 2013 with complete ABO blood type information. KaplanMeier was used to assess the effect of transfusions, stratified according to ABO type and Rh status, on CSM and OM. The same endpoints were tested in Cox regression models, after adjusting for year of surgery, age, gender, Charlson comorbidity index, intra- and post-op transfusions, Rh status, pre-op anemia, number of nodes removed, pathological T and N stage, surgical margins and adjuvant chemotherapy RESULTS: A total of 341 (46.8%), 277 (38.0%), 83 (11.4%) and 27 (3.7%) patients had blood type O, A, B and AB, respectively. Overall, 630 (86.5%) and 98 (13.5%) were Rh- and Rh+, respectively. At a median follow-up time of 65 months, 225 (30.9%) and 282 (38.7%) patients recorded CSM and OM, respectively. At univariable analyses, ABO blood type and Rh status were not associated to either CSM or OM (all p>0.2). Similar results were observed when ABO blood type and Rh status were tested in multivariable models (all p>0.3). Conversely, Charlson score, age, number of nodes removed, pathological T stage, pathological N stage, anemia status, and surgical margin status were associated to both CSM and OM (all p<0.05). Interestingly, intraop transfusion (all p <0.045) but not the administration of blood units in the post-op period (p>0.4) were associated with an increase of CSM and OM CONCLUSIONS: Although ABO type and/or Rh factor were associated with several adverse outcomes in many cancers, we were not able to confirm this association in BCa. Based on our results, the impact of transfusion on survival is independent by ABO type but is associated to the timing of blood supply administration. It may be argued that intra-operative transfusion may represent a proxy for more complex surgery and, in turn, for more advanced disease which may translate into a reduction of survival after surgery Source of Funding: none
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PD39-05 ONCOLOGICAL OUTCOMES OF TOTALLY INTRACORPOREAL ROBOT-ASSISTED RADICAL CYSTECTOMY: RESULTS FROM THE EUROPEAN ASSOCIATION OF UROLOGY ROBOTIC UROLOGY SECTION (ERUS) SCIENTIFIC WORKING GROUP Abolfazl Hosseini*, Justin Collins, Christofer Adding, Tommy Nyberg, Stockholm, Sweden; Anthony Koupparis, Edward Rowe, Bristol, United Kingdom; Matthew Perry, Rami Issa, London, United Kingdom; Martin Schumacher, Aarau, Switzerland; Carl Wijburg, Arnham, Netherlands; Erdem Canda, Ankara, Turkey; Mevlana Balbay, Istanbul, Turkey; Karel Decaestecker, Ghent, Belgium; Christian Schwentner, Arnulf Stenzl, Tubingen, Germany; Sebastian Edeling, Sasa Pokupic, Hanover, Germany; Khurshid Guru, Buffalo, NY; Alexander Mottrie, Aalst, Belgium; Peter Wiklund, Stockholm, Sweden INTRODUCTION AND OBJECTIVES: Data on the oncological outcomes in patients undergoing robot-assisted radical cystectomy (RARC) is limited. Globally extracorporeal urinary diversion following RARC remains the most common approach despite potential advantages of a completely minimally invasive approach. We report oncological outcomes and associated prognostic factors from a multiinstitutional European database focusing on the centres performing totally intracorporeal RARC. METHODS: Retrospective review of the prospectively populated ERUS scientific working group multi-institutional database identified 621 patients at 10 different Institutions (7 countries), with a minimum of 3 months follow-up, who underwent RARC with an intracorporeal urinary diversion between December 2003 and January 2015. Clinical, pathologic, and survival data at the latest follow-up were collected. RESULTS: Median age was 66 years, 83% were men. 95% of patients had transitional cell carcinoma. 112 (76%) patients were alive at the time of the analysis. 24% received neoadjuvant chemotherapy. The median follow-up time for patients was 19 months (IQR 11-36). 147 patients had a minimum of 3 years follow-up and 47 patients (32%) had undergone surgery 5 or more years ago. 30 patients (4.85%) had a positive surgical margin (PSM), of which 28 (93.3%) had T3/T4 disease, equivalent to 13.9% of all patients with T3/T4. Two patients (0.7%) with organ-confined disease had a PSM. The median yield for extended pelvic lymph node dissection was 18. The 5-year cancer specific survival (CSS), overall survival (OS) and recurrence free survival (RFS) were 73.8%, 70.5% and 71.6% respectively. On multivariable analysis, non-organ confined versus organ confined disease was found to impact CSS, OS and RFS (HR 4.5, 3.3 and 4.2 respectively). In this series no patient with pT0 has had a recurrence to date. CONCLUSIONS: Medium term follow-up for totally intracorporeal RARC shows acceptable survival outcomes comparable to open radical cystectomy series.