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Objectives: To evaluate the association between surgical modality (RARC vs. ORC) and the risk of 30-day complications., Materials and Methods: We utilized the American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) Cystectomy-Targeted database from 2019 to 2021. The primary outcome was a composite of major complications including 30-day mortality, reoperation, cardiac events, and stroke. Secondary outcomes included individual major and cystectomy-specific complications. Propensity score matching (PSM) was employed to minimize inherent differences within our cohort. We performed logistic regression to assess the association between outcomes of interest and operative modality., Results: We found no difference between operative modality and the primary outcome, however, RARC was associated with a 70% lower risk of 30-day mortality (OR 0.30, 95% CI 0.13-0.70) and had favorable outcomes with respect to respiratory, deep venous thrombosis, wound complications, and length of stay. Limitations are related to residual confounding given the observational methodology., Conclusions: RARC was associated with reduced risk of multiple 30-day complications, including mortality, as well as organ system and cystectomy-specific outcomes. These data support the clinical benefit of increased adoption of RARC., Competing Interests: Declaration of competing interest We declare that all the authors have no declarations and no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Robot-assisted radical cystectomy (RARC) is increasingly being used to treat muscle-invasive bladder cancer in an attempt to improve functional outcomes and complication rates over open radical cystectomy (ORC). We performed a meta-analysis of randomized controlled trials (RCTs) to compare patient outcomes between RARC and ORC. The primary outcome measure was a composite of recurrence-free survival (RFS) or progression-free survival (PFS). As a secondary measure, we examined other surrogate oncologic endpoints, perioperative outcomes, and complications. We found no difference between RARC and ORC with respect to RFS/PFS (hazard ratio 0.89, 95% confidence interval 0.64-1.24), surgical margin rates, or lymph node dissection yield. Analysis of patterns of recurrence for (pelvic) versus distant/abdominal sites indicated a significant difference between RARC and ORC (p=0.04). This analysis represents a combination of post hoc analyses using RCT data and inconsistent between-study definitions of recurrence sites, and must be interpreted with caution. Lastly, RARC was associated with an advantage in estimated blood loss, but a longer operative time, with no difference in hospital length of stay or complication rates. These data support the oncologic safety of RARC; however, further research is required to assess potential differences in recurrence patterns. PATIENT SUMMARY: We synthesized data from recent randomized controlled trials to examine differences in cancer control between minimally invasive, robot-assisted radical cystectomy and traditional, open radical cystectomy. Our study shows that cancer control outcomes are comparable between robotic and open techniques, supporting the safety of minimally invasive surgery. Blood loss was lower in robotic surgery, but the robotic procedure was longer and did not have lower complications rates after surgery., (Copyright © 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.)

Purpose Multidisciplinary management improves complex treatment decision making in cancer care, but its impact for bladder cancer (BC) has not been documented. Although radical cystectomy (RC) currently is viewed as the standard of care for muscle-invasive bladder cancer (MIBC), radiotherapy-based, bladder-sparing trimodal therapy (TMT) that combines transurethral resection of bladder tumor, chemotherapy for radiation sensitization, and external beam radiotherapy has emerged as a valid treatment option. In the absence of randomized studies, this study compared the oncologic outcomes between patients treated with RC or TMT by using a propensity score matched-cohort analysis. Methods Data from patients treated in a multidisciplinary bladder cancer clinic (MDBCC) from 2008 to 2013 were reviewed retrospectively. Those who received TMT for MIBC were identified and matched (for sex, cT and cN stage, Eastern Cooperative Oncology Group status, Charlson comorbidity score, treatment date, age, carcinoma in situ status, and hydronephrosis) with propensity scores to patients who underwent RC. Overall survival and disease-specific survival (DSS) were assessed with Cox proportional hazards modeling and a competing risk analysis, respectively. Results A total of 112 patients with MIBC were included after matching (56 who had been treated with TMT, and 56 who underwent RC). The median age was 68.0 years, and 29.5% had stage cT3/cT4 disease. At a median follow-up of 4.51 years, there were 20 deaths (35.7%) in the RC group (13 as a result of BC) and 22 deaths (39.3%) in the TMT group (13 as a result of BC). The 5-year DSS rate was 73.2% and 76.6% in the RC and TMT groups, respectively ( P = .49). Salvage cystectomy was performed in 6 (10.7%) of 56 patients who received TMT. Conclusion In the setting of a MDBCC, TMT yielded survival outcomes similar to those of matched patients who underwent RC. Appropriately selected patients with MIBC should be offered the opportunity to discuss various treatment options, including organ-sparing TMT.

Robot-assisted radical cystectomy (RARC) is an evolving technique for the treatment of muscle-invasive bladder cancer (MIBC); however, its effectiveness compared with open radical cystectomy (ORC) - the established modality - is debated. Six specific areas of evidence are critically important for supporting the continuing use of RARC for MIBC, including technical aspects of surgery, perioperative outcomes, complications, oncological outcomes, functional outcomes, and financial costs. Considerable progress has been made regarding these aspects and data show that RARC replicates the technical benchmarks of ORC in terms of success of cystectomy, lymph node dissection, and urinary diversion, and could offer advantages over the more-established technique. Despite some clear benefits of RARC (such as reduced blood loss) other perioperative outcomes, including duration of inpatient stay and 30-90 day complication rates, seem to be similar to those of ORC. Current data on oncological and functional outcomes are promising, but robust data from prospective studies will help determine the indications for use of RARC for treating MIBC in the future.

Objective: To assess the utility of routine frozen section analysis of ureters at the time of radical cystectomy (RC) for urothelial cancer (UC), and the long-term outcomes of adverse ureteric pathology., Patients and Methods: Pathological data on 2 047 patients undergoing RC for UC with routine frozen section analysis of ureters (January 1971 to December 2009) were analysed. Univariate and multivariable logistic and Cox proportional hazards models were used to determine the risk of upper tract UC (UTUC) recurrence, local recurrence and overall survival in those identified as having adverse pathology (severe atypia/carcinoma in situ [CIS] or UC) at time of frozen section analysis., Results: Adverse pathology was identified by frozen section analysis in 178 patients (8.6%). Frozen section analysis was found to have poor sensitivity in identifying adverse pathology (59.1%), which was improved in patients with preoperative CIS (68.0%). After a median (interquartile range) follow-up of 12.4 (1.9-10.1) years, 28 patients (1.4%) developed UTUC recurrence. There were no uretero-enteric anastomotic recurrences. Adverse pathology on frozen section analysis was associated with UTUC recurrence on univariate analysis (hazard ratio [HR] 6.2, 95% confidence interval [CI] 2.9-13.5), but 15/28 patients (54%) with UTUC recurrence had benign ureteric frozen section analysis on initial sectioning. Adverse pathology on frozen section analysis was not independently associated with the risk of local recurrence (HR 1.08, 95% CI 0.61-1.89) or overall survival (HR 1.12, 95% CI 0.94-1.35) in multivariate models., Conclusions: Ureteric frozen section analysis has poor sensitivity and may be marginally improved in pre-existing CIS. UTUC recurrence is rare and can occur despite negative frozen section analysis. Our data question the utility of routine frozen section analysis of the distal ureteric margin at the time of RC., (© 2015 The Authors BJU International © 2015 BJU International Published by John Wiley & Sons Ltd.)

Purpose: To characterize the clinical and pathologic staging of patients with urothelial carcinoma (UC) in bladder diverticula (BD) after undergoing radical cystectomy (RC) and determine the impact of UCBD on recurrence and survival., Methods: We reviewed our institutional database of patients who underwent RC for UC (1971-2009). Outcomes were compared between patients with and without UCBD. Kaplan-Meier curves estimated recurrence-free survival (RFS) and overall survival (OS). Multivariable Cox regression evaluated associations between UCBD and survival., Results: Inclusion criteria were met in 1991 patients. UCBD was seen in 77 (4 %) patients and occurred exclusively in men (mean age 68 ± 8.5 years). The highest pathologic stage tumor was found in the BD in 44 (57 %) of these patients. Pathologic upstaging was more common with UCBD compared with UC not in BD (48 vs. 39 %, p = 0.031). On univariate analysis, no differences in RFS or OS were observed comparing patients with or without UCBD stratified by clinically organ-confined (≤T2) and extravesical (>T2) disease. On multivariable analysis, the presence of UCBD was not associated with differences in RFS (HR 0.92, 95 % CI 0.59-1.42, p = 0.69) or OS (HR 0.98, 95 % CI 0.74-1.31, p = 0.92)., Conclusion: Upstaging was common in patients with UCBD, observed in almost half of the patients. There were no differences in RFS or OS after RC when comparing patients with or without UC in a diverticulum stratified by stage.

The clinical utility of intraoperative frozen section analysis (FSA) of ureters at the time of radical cystectomy (RC) for urothelial cancer (UC) remains controversial and subject to considerable debate. Potential advantages include intraoperative detection of carcinoma in situ (CIS) or overt malignancy and directed ureteral sectioning to achieve negative margins to reduce anastomotic recurrence. The information gained at the time of FSA may be useful for risk-adapted upper tract surveillance. To critically assess the utility of FSA with respect to these potential advantages, we review the operating characteristics of FSA as a diagnostic test, the relationship between upper tract urothelial carcinoma (UTUC) recurrence and abnormal FSA, and the overall evidence for FSA on oncological end points and cost-effectiveness. Taken together, the weight of evidence suggests that while FSA is a reasonable diagnostic test, its utility has been recently questioned, and prospective study is warranted. There is a need to quantify the risk reduction in anastomotic recurrence in light of the cost-effectiveness of FSA compared to the alternative of only performing permanent analysis of proximal ureteral margins. Given the low rates of UTUC recurrence reported in the literature, the weak association between FSA and these recurrences, and mortality in retrospective studies, the clinical impact of reducing UTUC recurrence by FSA must continue to be critically evaluated.

Purpose of Review: Surgical techniques to spare female reproductive organs at the time of radical cystectomy [reproductive organ-sparing radical cystectomy (ROSRC)] have been advocated to improve quality of life with respect to sexual and urinary function. These potential benefits must be weighed against the risk of inappropriate patient selection and related oncologic risk., Recent Findings: In this review, we describe the evidence to define the appropriate selection criteria to minimize clinical understaging. The literature provides small cohorts with intermediate-term follow-up to support oncologic safety, and thus ROSRC must continue to be evaluated with long-term studies. Pertinent techniques for ROSRC are described based on underlying anatomic principles. Lastly, studies on the potential sexual and urinary functional advantages are promising, but must be evaluated in light of the excellent baseline functional characteristics of those selected for inclusion., Summary: ROSRC appears to provide measurable benefits to sexual and urinary function. However, the magnitude of these benefits is unclear and the selection of appropriate candidates requires further prospective study vis-a-vis oncologic control. ROSRC must be adopted cautiously until further data are available.

Purpose: To determine the feasibility and develop a robotic technique for intracorporeal implantation of a biodegradable tubular scaffold seeded with adipose-sourced smooth muscle cells (Neo-Urinary-Conduit) that, when implanted as a conduit for urinary diversion, facilitates regeneration of native-like neourinary tissue., Materials and Methods: Robotic NUC implantation was performed in two fresh male cadavers. The greater omentum was widely detached from the greater curvature of the stomach, in preparation for final wrapping of the conduit. Bilateral ureters were mobilized for implantation. The NUC, with two precreated ureteral openings, was inserted into the abdomen. Bilateral, stented uretero-NUC anastomoses were created. The NUC was circumferentially wrapped with the predissected omentum, exteriorized through the abdominal wall, and maturated., Results: Both procedures were successfully completed intracorporeally. Operative time for NUC implantation was 90 and 100 minutes, respectively. Examination of gross anatomy showed no injury to other organs. There was no omental kinking, rotation, eversion, or stripping from the NUC. Bilateral stents were confirmed to be in situ with the proximal coil in the kidney. Uretero-NUC anastomoses and omentum were tension free. The entire NUC, including its distal edge and posterior aspect, was circumferentially wrapped 360 degrees., Conclusion: We demonstrated the feasibility and developed a robotic technique for intracorporeal implantation of a biodegradable regenerative urinary conduit. This study serves as the foundation for the robotic surgical technique before the clinical application.

Purpose: The use of cavernous nerve interposition grafting to preserve erectile function in men who require neurovascular bundle resection for cancer control is controversial. We report outcomes and predictors of cavernous nerve interposition grafting in men undergoing unilateral grafting during radical prostatectomy or bilateral grafting during radical cystectomy and prostatectomy with autologous nerve grafts., Materials and Methods: We retrospectively reviewed the electronic records of 36 patients who underwent cavernous nerve interposition grafting between 2003 and 2006. Postoperatively erectile function was assessed with the International Index of Erectile Function 15-item questionnaire. Predictors of potency, including age at surgery, time since surgery and prostate specific antigen at surgery, were assessed by univariate analysis., Results: A total of 33 patients (92% response rate) were followed for a median of 32, 25 and 11 months after bilateral grafting during radical cystectomy (10), unilateral grafting during radical prostatectomy (20), and bilateral grafting during radical cystectomy and prostatectomy (3), respectively. The rate of potency, defined as the ability to attain and maintain erection sufficient for penetration at least 50% of the time with or without phosphodiesterase-5 inhibitors, was 31% (5 of 13 men) for unilateral grafts, 38% (5 of 16) for bilateral grafts and 30% (3 of 10) for bilateral grafts during radical cystectomy. Age at surgery was the only significant determinant of potency and it showed an inverse relationship in the bilateral nerve graft group (p = 0.02)., Conclusions: Cavernous nerve interposition grafting appears to have a role in the recovery of erectile function. To our knowledge this study represents the largest series of cavernous nerve interposition grafting during cystectomy and it suggests that this should be considered during bilateral neurovascular bundle resection.

Background Intracorporeal orthotopic neobladder (iONB) creation following robotic radical cystectomy is an emerging procedure and robust functional data are required. Objective To evaluate urodynamic features of iONB and bladder cancer–specific and general health-related quality-of-life (HRQOL) outcomes. Design, setting, and participants We retrospectively assessed 28 men who underwent iONB creation (January 2012 to October 2013) and compared results to a previously characterized cohort of 79 of open ONB procedures. Outcome measurements and statistical analysis iONB pressure-volume properties were characterized using multichannel urodynamics (UDS). The Bladder Cancer Index (BCI) questionnaire, modified with mucus- and pad-related questions, and the Short Form Health Survey (SF-36) were used to evaluate urinary function and HRQOL. ONB cohorts were compared for functional outcomes and BCI score. Multivariable linear regression was used to assess predictors of BCI score. Results and limitations The median follow-up was 9.4 mo for the iONB and 62.1 mo for the open ONB group ( p < 0.0001); ≥2-yr follow-up had been completed for one (4%) patient in the iONB group compared to 75 (95%) patients in the open ONB group ( p < 0.0001). In UDS tests, the iONB group had minimal postvoid residual volume, normal compliance, and a mean capacity of 514 cm 3 (range 339–1001). BCI mean scores for urinary function ( p = 0.58) and urinary bother ( p = 0.31) were comparable between the groups. The surgical approach was not associated with the BCI score on multivariable analysis. Rates of 24-h pad use were comparable between iONB and open ONB groups (pad-free 17% vs 19%; ≤2 pads 84% vs 79%), as reflected by total pad usage ( p = 0.1); pad size and daytime wetness were worse in the iONB group. The clean intermittent catheterization rate was 10.7% in the iONB and 6.3% in the open ONB group. Limitations include the retrospective comparison, small number of patients and short follow-up for the iONB group. Conclusions iONB had adequate UDS characteristics and comparable bladder cancer–specific HRQOL scores to open ONB. However, pad size and daytime wetness were worse for iONB, albeit over significantly shorter follow-up. Patient summary We demonstrate that the volumetric and pressure characteristics are acceptable for a neobladder created using an entirely robot-assisted laparoscopic technique after bladder removal for cancer. Urinary function and quality-of-life outcomes related to the robotic technique were compared to those for neobladders created via an open surgical technique. We found that urinary function and bother indices were comparable; however, the robotic group required larger incontinence pads that were wetter during the daytime. This may be explained by the significantly shorter duration of recovery after surgery in the robotic group. [ABSTRACT FROM AUTHOR]

Purpose: To describe our approach for port placement and robot docking for pelvic and kidney surgery (KS). Patients and Methods: We use a four-arm robotic approach and a 5 to 6 port placement consisting of: One 12-mm camera port, three 8-mm robotic ports, and one to two assistant ports. For radical prostatectomy, the working robotic ports run parallel below the level of the umbilicus. Radical cystectomy ports are more cephalad and above the level of the umbilicus. For transperitoneal KS, two bariatric robotic ports are used, aiming for an equilateral triangle configuration. With retroperitoneal (RN) KS, a balloon dilator and balloon port create the RN space; bariatric ports comprise the most anterior and posterior ports. Results: This technique has been used since 2010 on more than 2370 robotic urologic cases. To date, no procedure has needed patient or robot positioning while maintaining fourth arm functionality with minimal robotic arm clashing. Conclusions: Our approach of port placement and robot docking is reproducible and feasible for pelvic surgical procedures and KS. [ABSTRACT FROM AUTHOR]

Objective The location of positive lymph nodes (LNs) is important for bladder cancer staging. Little is known regarding the impact of perivesical (PV) lymph node (PVLN) involvement on survival. This study characterized PVLN identified after radical cystectomy (RC) and analyzed their impact on recurrence and survival. Materials and methods We reviewed our institutional review board–approved database including all patients who underwent RC with pelvic lymphadenectomy for curative intent for urothelial carcinoma. Clinical and pathologic data were obtained. Patients were analyzed in groups according to the location of positive LNs: PV+/other LN (ON)+, PV+/ON−, and PV−/ON+. Kaplan-Meier curves were used to estimate recurrence-free survival (RFS) and overall survival (OS). Multivariable Cox regression (including pathologic T category, number of positive LNs, highest level of positive LNs, chemotherapy, and margin status) was performed to evaluate associations between PVLN status and survival. Results In total, 2,017 patients met inclusion criteria and 465 (23%) were LN+. PVLNs were identified in 936 patients (47%), positive in 197 patients (10%), and represented isolated LN+disease in 101 patients (5%). On univariate analysis, RFS and OS were significantly worse in the PV+/ON+group compared with the PV+/ON− and PV−/ON+ groups. There were no significant differences in RFS or OS between the PV+/ON− and PV−/ON+ groups. On multivariable analysis, PV+/ON+disease was independently associated with worse RFS and OS when compared with PV−/ON+ disease. Conclusions PVLNs were identified in a significant number of patients after RC. Positive PVLN, when in combination with other positive LNs, portends worse survival even when correcting for the number of positive nodes. [ABSTRACT FROM AUTHOR]

Introduction: Radical cystectomy is a highly morbid procedure with 30-day perioperative complication rates approaching 50%. Our objective was to determine the effect of patients' body mass index (BMI) on perioperative outcomes following radical cystectomy for bladder cancer. Methods: We identified 3930 eligible patients who underwent radical cystectomy for nonmetastatic bladder cancer using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. The primary exposure was preoperative BMI, categorically operationalized in four strata according to the World Health Organization criteria: <18.5 kg/m², 18.5-25 kg/m², 25-30 kg/m², and >30 kg/m². Our primary outcome was major perioperative complication comprising mortality, reoperation, cardiac event, or neurological event. Results: BMI was significantly associated with rates of major complications (p=0.003): major complications were experienced by 17.0% of patients with BMI <18.5 kg/m², 7.8% of patients with BMI 18.5-25 kg/m², 7.9% of patients with BMI 25-30 kg/m², and 10.8% of patient with BMI >30 kg/m². Following multivariable adjustment for relevant demographic, comorbidity, and treatment factors, compared to patients with BMI 18.5-25 kg/m², patients with BMI <18.5 kg/m² (odds ratio [OR] 2.28; 95% confidence interval [CI] 1.07-4.78) and BMI >30 kg/m² (OR 1.59;95% CI 1.17-2.16) were significantly more likely to experience a major complication in the 30 days following cystectomy. Among the secondary outcomes, significant differences were identified in rates of pulmonary complications (p=0.003), infectious complications (p<0.001), bleeding requiring transfusion (p=0.01), and length of stay (p=0.001). Conclusions: Patients who are outside of a normal BMI range are more likely to experience major complications following radical cystectomy for bladder cancer. [ABSTRACT FROM AUTHOR]

Introduction: There are no meta-analyses of randomized controlled trials (RCTs) comparing open radical cystectomy (ORC) with robot-assisted radical cystectomy (RARC), inclusive of both intracorporeal (iRARC) and extracorporeal (hybrid RARC, hRARC) urinary reconstruction. Methods: MEDLINE, Embase, Scopus, the International Clinical Trials Registry Platform and ClinicalTrials.gov registries were searched in May 2022. Outcomes of interest included recurrence-or progression-free survival (RFS/PFS), margin status and lymph node yield, mean estimated blood loss (EBL) and operating room time (ORT), hospital length of stay (LOS), 90-day complications and readmissions, and quality of life (QoL). Pairwise meta-analyses and network meta-analyses were performed using random-effects models and Bayesian hierarchical random-effects models, respectively. Results: We found no significant differences between RARC and ORC for oncological and most perioperative outcomes: RFS/PFS (hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.67-1.23); positive surgical margins (odds ratio [OR] 1.05, 95% CI 0.60-1.85); lymph node yield (mean difference [MD] -0.63, 95% CI -2.63-1.37); LOS (MD -0.22, 95% CI -1.10-0.65); overall complications (OR 0.81, 95% CI 0.61-1.07); major complications (OR 0.94, 95% CI 0.69-1.30); readmissions (OR 0.90, 95% CI 0.60-1.35); and QoL (standardized MD -0.02, 95% CI -0.17-0.14). We found significantly lower EBL for RARC compared to ORC (MD -312.61, 95% CI - 447 to -178.22) at the expense of significantly prolonged ORT (MD 82.34 minutes, 95% CI 44.82-119.86). Network meta-analysis did not find significant differences in complications between hRARC and iRARC. Conclusions: This meta-analysis confirms the equivalence of RARC and ORC with respect to oncological outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Development of uretero-ileal stricture (UIS) after robotic-assisted radical cystectomy (RARC) may be dependent on surgical technique. Video review of intraoperative technique is an emerging paradigm for surgical quality improvement. We examined whether surgeon-perceived risk of UIS or crowd-sourced assessment of robotic skill are associated with the development of UIS. Methods: We conducted a case-control study comparing the operative technique of uretero-ileal anastomoses resulting in clinically significant UIS with the contralateral anastomosis for the same patient. De-identified videos were analyzed by 1) five high-volume surgeons; and 2) crowd workers (Crowd-Sourced Assessment of Technical Skill, C-SATS) to determine Global Evaluative Assessment of Robotic Skill (GEARS) score. Mantel-Haenszel common odds ratio (OR) estimates were calculated to assess the association between surgeon performance and the development of UIS. Logistic regression models were used to examine the association between GEARS scores and the development of UIS. Results: A total of 10 UIS videos were compared to eight control videos by five surgeons and 2142 crowd workers. Expert surgeons systematically evaluated intraoperative footage, however, no association between the expert mode response and UIS (OR 0.42; 95% confidence interval [CI] 0.05-3.45; p=0.91) was identified. Crowd-sourced assessment was not predictive of UIS (p=0.62). Conclusions: We used video review to systematically analyze procedure-specific content and technique. The inability of surgeons to predict UIS may reflect the questionnaire, uncontrolled patient factors, or a lack of power. Crowd-sourced GEARS score was unsuccessful in predicting UIS after RARC. [ABSTRACT FROM AUTHOR]

Introduction: We sought to determine the effect of the presence of disseminated disease on perioperative outcomes following radical cystectomy for bladder cancer. Methods: We identified 4108 eligible patients who underwent radical cystectomy for bladder cancer using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database. We matched patients with disseminated cancer at the time of surgery to those without disseminated cancer using propensity scores. The primary outcome of interest was major complications (death, reoperation, cardiac or neurological event). Secondary outcomes included pulmonary, infectious thromboembolic, and bleeding complications, in addition to prolonged length of stay. Generalized estimating equations were used to examine the association between disseminated cancer and the development of complications. Results: Following propensity score matching and adjusting for the type of urinary diversion, radical cystectomy in patients with disseminated disease was associated with a significant increase in major complications (8.6% vs. 4.0%; odds ratio [OR] 2.50; 95% confidence interval [CI] 1.02-6.11; p=0.045). The presence of disseminated disease was associated with an increase in pulmonary complications (5.8% vs. 1.2%; OR 5.17. 95% CI 1.00-26.66. p=0.049), but not infectious complications, venous thromboembolism, bleeding requiring transfusion, and prolonged length of stay (p values 0.07-0.79). Conclusions: Patients with disseminated cancer undergoing cystectomy are more likely to experience major and pulmonary complications. The strength of these conclusions is limited by sample size, selection bias inherent in observational data, and a lack of specific oncological detail in the database. [ABSTRACT FROM AUTHOR]