AB009. SOH25_AB_386. Robotic nephroureterectomy with partial cystectomy and iliac lymphadenectomy in a complex case of post-neo-adjuvant chemotherapy for muscle-invasive urothelial cancer of vesicoureteric junction

Background: Management of muscle-invasive high-grade urothelial cancer of the vesicoureteric junction (VUJ) is challenging. Neoadjuvant chemotherapy downsizes primary tumor and metastatic lymph nodes at the expense of desmoplastic reaction. We report our technique and experience of a complex case of urothelial cancer involving VUJ with iliac lymphadenopathy using a dual console da Vinci Xi surgical system.

Methods: A 72-year-old male with high-grade urothelial cancer involving the VUJ and iliac lymphadenopathy underwent neo-adjuvant chemotherapy following discussion at our multidisciplinary meetings (MDM). Significant downsizing of the primary tumor and lymph nodal mass was noted post-neoadjuvant chemotherapy on a follow-up computed tomography (CT) scan. Following discussion at MDM and extensive counselling of the patient, the decision was made for a robotic nephroureterectomy with partial cystectomy and lymphadenectomy. We describe operative details and our technique in the video.

Results: A transperitoneal approach using a Dual console Xi robotic platform was utilized. Extensive desmoplastic reaction was observed during the dissection of the distal ureter with tumor mass and at the pelvic sidewall lymph node mass. Kidneys with ureter excised along with part of adjacent bladder (partial cystectomy). Primary repair of the bladder was performed with an absorbable suture. Ipsilateral iliac lymphadenectomy was performed. Console time was 140 min. Blood loss was 100 mL. The patient made an uneventful recovery and was discharged on day 4 postoperatively. At 6 months post-operative, imaging studies revealed no evidence of local recurrence or metastasis.

Conclusions: Robotic nephroureterectomy with partial cystectomy and pelvic lymphadenectomy is a safe and highly effective technique in the management of urothelial cancer of VUJ post-neo-adjuvant chemotherapy.

Keywords: High-grade urothelial cancer; vesicoureteric junction (VUJ); robotic; partial cystectomy; nephroureterectomy; lymphadenectomy