Robot-Assisted Radical Cystectomy: Recommendations from Latin American Experts Consensus on Surgical Strategy, Urinary Reconstruction, and Oncological and Functional Outcomes
Year: 2026
Type: article
Abstract: PURPOSE: To develop contemporary evidence-informed recommendations for robot-assisted radical cystectomy (RARC), urinary reconstruction, and perioperative management, integrating current evidence with the experience of Latin American experts in uro-oncology and robotic surgery. 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.
Source: International braz j urol
Authors: Eliney Ferreira Faria, Alejandro Rodriguez, Alexandre Pompeo, Arnaldo Fazoli, Carlos Vaz, Carlos Watanabe, Clovis Fraga, Daher Chade, Eder Brazão, Elias Bodden, Fernando Korkes, Flávio Cárcano, Francisco Hidelbrando Filho, Gilberto Almeida, Gustavo Guimarães, Hamilton Zampoli, Joan Palou, Jose Alexandre Pedrosa, Lucas Fornazieri, Marcelo Kerkebe, Marcio Moschovas, Marcos Tobias-Machado, Matheus Nister, Matheus Paiva, Murilo Luz, Nilo Jorge, Pablo Melo, Pedro Romanelli, Peter Wiklund, Rafael Coelho, Raphael Rocha, Rene Sotelo, Reza Mehrazin, Roberto Machado, Rodolfo Borges, Rodrigo Valente, Ronald Kool, Stenio Zequi, Sérgio Zacchi, Vipul Patel, Wenceslao Villamil, Rodrigo Gualberto
Institutions: Faculdade de Ciências Médicas de Minas Gerais, Southeastern Baptist Theological Seminary, Wake Forest University, Hospital do Coração, Hospital Felício Rocho, Hospital Sírio-Libanês, Real Hospital Português, AC Camargo Hospital, Hospital Punta Pacifica, Faculdade de Medicina do ABC, Universidade do Vale do Itajaí, Puigvert Foundation, Instituto Nacional de Câncer - INCA, University of Chile, Hospital Madre Teresa, Icahn School of Medicine at Mount Sinai, Universidade Federal de Minas Gerais, Mount Sinai Hospital, Research Medical Center, University of Southern California, Hospital Erasto Gaertner, Hospital Italiano de Buenos Aires
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7169513233