Robot-Assisted Radical Cystectomy: Recommendations from Latin American Experts Consensus on Surgical Strategy, Urinary Reconstruction, and Oncological and Func-tional Outcomes.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Faria Eliney Ferreira, Rodriguez Alejandro, Pompeo Alexandre, Fazoli Arnaldo, Vaz Carlos, Watanabe Carlos, Fraga Clovis, Chade Daher, Brazão Eder, Bodden Elias, Korkes Fernando, Cárcano Flávio, Hidelbrando Francisco, Almeida Gilberto, Guimarães Gustavo, Zampoli Hamilton, Palou Joan, Pedrosa Jose Alexandre, Fornazieri Lucas, Kerkebe Marcelo, Moschovas Marcio, Tobias-Machado Marcos, Nister Matheus, Paiva Matheus, Luz Murilo, Jorge Nilo, Melo Pablo, Romanelli Pedro, Wiklund Peter, Coelho Rafael, Rocha Raphael, Sotelo Rene, Mehrazino Reza, Machado Roberto, Borges Rodolfo, Valente Rodrigo, Kool Ronald, Zequi Stenio, Zacchi Sérgio, Patel Vipul, Villamil Wenceslao, Gualberto Rodrigo
Аннотация
MATERIALS AND METHODS: A modified Delphi consensus process was conducted involving 42 experts with extensive experience in RARC. Topics included patient selection, perioperative optimization, enhanced recovery after surgery (ERAS), lymph node dissection, urinary reconstruction, functional preservation, perioperative systemic therapy, complex clinical scenarios, and emerging robotic technologies. A comprehensive literature review was performed using Medline, Scopus, and Web of Science through November 2025, following PRISMA principles and incorporating recommendations from EAU, AUA/ASCO/SUO, and NCCN guidelines. Consensus was defined as ≥75% agreement.
RESULTS: Consensus supported routine implementation of ERAS protocols, structured frailty and nutritional assessment, extended pelvic lymph node dissection, and perioperative systemic therapy in eligible patients. Intracorporeal urinary diversion was associated with improved recovery and lower wound-related morbidity. Nerve-sparing and organ-preserving approaches were recommended in selected patients to optimize continence, sexual function, and quality of life. Orthotopic neobladder reconstruction should be individualized according to oncologic safety, functional status, renal function, and patient preference. RARC was considered feasible in complex settings, including obesity, bulky lymphadenopathy, locally advanced disease, and salvage surgery, when performed in experienced high-volume centers. Areas without consensus included urinary drainage strategies and antibiotic prophylaxis duration.
CONCLUSIONS: This expert consensus provides recommendations for RARC and urinary reconstruction, aiming to standardize practice, optimize perioperative care, and improve oncological and functional outcomes. Future prospective studies are needed.