---
title: "Perioperative outcomes and 90-day mortality after robot-assisted radical cystectomy in four Japane"
id: "pubmed-42920004"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42920004"
content_type: "clinical_feed_article"
specialty: "Oncology"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42920004/"
doi: "10.1007/s11701-026-04107-9"
published_at: "2026-10-24T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# Perioperative outcomes and 90-day mortality after robot-assisted radical cystectomy in four Japane
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42920004
- **Specialty:** [Oncology](https://medichelpline.com/clinical-feed/oncology.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42920004/)
- **DOI:** [10.1007/s11701-026-04107-9](https://doi.org/10.1007%2Fs11701-026-04107-9)
- **Published At:** 2026-10-24T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- Multicenter retrospective review of 519 consecutive **robot-assisted radical cystectomy** (RARC) procedures for **bladder cancer**, performed October 2014–March 2026 across four Japanese institutions. - The cohort was split chronologically at each center into early (n = 261) and late (n = 258) halves to compare practice changes and outcomes over time. - Major complications within 90 days (Clavien-Dindo grade ≥3) occurred in 64 patients (12.3%); the early-phase rate was 14.6% versus 10.1% in the late phase. - Adjusted odds ratio for major complications in the late versus early phase was 0.67 (95% CI 0.39–1.14), per logistic regression that included institution as a covariate. - Thirteen patients (2.5%) died within 90 days; six deaths (1.2%) were classified as complication-related. Those who died were older and had worse performance status, investigators reported. - Use of pelvic lymph node dissection fell from 95.4% in the early half to 83.3% in the late half; pNx rates rose from 4.6% to 16.7%, largely driven by one institution. - Pathologic advanced primary stage (pT3-4) decreased from 35.8% to 23.8% between early and late phases. - In landmark analysis among 90-day survivors, the late phase was not significantly associated with overall survival (HR 0.70, 95% CI 0.45–1.08), cancer-specific survival (HR 0.65 reported), or recurrence-free survival (HR 0.74 reported). - Major complications were not associated with survival in the landmark analysis. - Study authors emphasized that temporal differences in tumor stage, lymph node dissection rates, and follow-up limit attribution of outcome changes to surgical experience.
## Clinical Analysis & Structured Key Points
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Real-world implementation of robot-assisted radical cystectomy at four Japanese institutions: perioperative outcomes, major complications, and mortality [Yutaro Sasaki](https://pubmed.ncbi.nlm.nih.gov/?term=Sasaki+Y&cauthor_id=42920004)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#full-view-affiliation-1 "Department of Urology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan. yutaro_sasaki@tokushima-u.ac.jp."), [Kyotaro Fukuta](https://pubmed.ncbi.nlm.nih.gov/?term=Fukuta+K&cauthor_id=42920004)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#full-view-affiliation-2 "Department of Urology, Tokushima Prefectural Central Hospital, 1-10-3 Kuramoto-cho, Tokushima, 770-8539, Japan."), [Fumiya Kadoriku](https://pubmed.ncbi.nlm.nih.gov/?term=Kadoriku+F&cauthor_id=42920004)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#full-view-affiliation-3 "Department of Urology, Takamatsu Red Cross Hospital, 4-1-3 Ban-cho, Takamatsu, 760-0017, Japan."), [Katsuhito Hori](https://pubmed.ncbi.nlm.nih.gov/?term=Hori+K&cauthor_id=42920004)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#full-view-affiliation-4 "Department of Urology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, 790-0024, Japan."), [Yuichiro Atagi](https://pubmed.ncbi.nlm.nih.gov/?term=Atagi+Y&cauthor_id=42920004)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#full-view-affiliation-2 "Department of Urology, Tokushima Prefectural Central Hospital, 1-10-3 Kuramoto-cho, Tokushima, 770-8539, Japan."), [Ryoei Minato](https://pubmed.ncbi.nlm.nih.gov/?term=Minato+R&cauthor_id=42920004)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#full-view-affiliation-5 "Department of Urology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan."), [Kei Daizumoto](https://pubmed.ncbi.nlm.nih.gov/?term=Daizumoto+K&cauthor_id=42920004)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#full-view-affiliation-5 "Department of Urology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan."), [Kazuyoshi Izumi](https://pubmed.ncbi.nlm.nih.gov/?term=Izumi+K&cauthor_id=42920004)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#full-view-affiliation-3 "Department of Urology, Takamatsu Red Cross Hospital, 4-1-3 Ban-cho, Takamatsu, 760-0017, Japan."), [Tomoya Fukawa](https://pubmed.ncbi.nlm.nih.gov/?term=Fukawa+T&cauthor_id=42920004)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#full-view-affiliation-5 "Department of Urology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan."), [Yutaka Yanagihara](https://pubmed.ncbi.nlm.nih.gov/?term=Yanagihara+Y&cauthor_id=42920004)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#full-view-affiliation-4 "Department of Urology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, 790-0024, Japan."), [Iku Ninomiya](https://pubmed.ncbi.nlm.nih.gov/?term=Ninomiya+I&cauthor_id=42920004)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#full-view-affiliation-4 "Department of Urology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, 790-0024, Japan."), [Ryoichi Nakanishi](https://pubmed.ncbi.nlm.nih.gov/?term=Nakanishi+R&cauthor_id=42920004)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#full-view-affiliation-2 "Department of Urology, Tokushima Prefectural Central Hospital, 1-10-3 Kuramoto-cho, Tokushima, 770-8539, Japan."), [Hirofumi Izaki](https://pubmed.ncbi.nlm.nih.gov/?term=Izaki+H&cauthor_id=42920004)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#full-view-affiliation-2 "Department of Urology, Tokushima Prefectural Central Hospital, 1-10-3 Kuramoto-cho, Tokushima, 770-8539, Japan."), [Masahito Yamanaka](https://pubmed.ncbi.nlm.nih.gov/?term=Yamanaka+M&cauthor_id=42920004)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#full-view-affiliation-3 "Department of Urology, Takamatsu Red Cross Hospital, 4-1-3 Ban-cho, Takamatsu, 760-0017, Japan."), [Kenjiro Okamoto](https://pubmed.ncbi.nlm.nih.gov/?term=Okamoto+K&cauthor_id=42920004)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#full-view-affiliation-4 "Department of Urology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, 790-0024, Japan."), [Junya Furukawa](https://pubmed.ncbi.nlm.nih.gov/?term=Furukawa+J&cauthor_id=42920004)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#full-view-affiliation-5 "Department of Urology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan.") Affiliations Expand ### Affiliations * 1 Department of Urology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan. yutaro_sasaki@tokushima-u.ac.jp. * 2 Department of Urology, Tokushima Prefectural Central Hospital, 1-10-3 Kuramoto-cho, Tokushima, 770-8539, Japan. * 3 Department of Urology, Takamatsu Red Cross Hospital, 4-1-3 Ban-cho, Takamatsu, 760-0017, Japan. * 4 Department of Urology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, 790-0024, Japan. * 5 Department of Urology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan. * PMID: **42920004** * DOI: [ 10.1007/s11701-026-04107-9 ](https://doi.org/10.1007/s11701-026-04107-9) Item in Clipboard Multicenter Study # Real-world implementation of robot-assisted radical cystectomy at four Japanese institutions: perioperative outcomes, major complications, and mortality Yutaro Sasaki et al. J Robot Surg. 2026. Show details Display options Display options Format Abstract PubMed PMID J Robot Surg Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22J+Robot+Surg%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22J+Robot+Surg%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42920004/) . 2026 Oct 24;20(1):1129. doi: 10.1007/s11701-026-04107-9. ### Authors [Yutaro Sasaki](https://pubmed.ncbi.nlm.nih.gov/?term=Sasaki+Y&cauthor_id=42920004)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#short-view-affiliation-1 "Department of Urology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan. yutaro_sasaki@tokushima-u.ac.jp."), [Kyotaro Fukuta](https://pubmed.ncbi.nlm.nih.gov/?term=Fukuta+K&cauthor_id=42920004)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#short-view-affiliation-2 "Department of Urology, Tokushima Prefectural Central Hospital, 1-10-3 Kuramoto-cho, Tokushima, 770-8539, Japan."), [Fumiya Kadoriku](https://pubmed.ncbi.nlm.nih.gov/?term=Kadoriku+F&cauthor_id=42920004)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#short-view-affiliation-3 "Department of Urology, Takamatsu Red Cross Hospital, 4-1-3 Ban-cho, Takamatsu, 760-0017, Japan."), [Katsuhito Hori](https://pubmed.ncbi.nlm.nih.gov/?term=Hori+K&cauthor_id=42920004)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#short-view-affiliation-4 "Department of Urology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, 790-0024, Japan."), [Yuichiro Atagi](https://pubmed.ncbi.nlm.nih.gov/?term=Atagi+Y&cauthor_id=42920004)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#short-view-affiliation-2 "Department of Urology, Tokushima Prefectural Central Hospital, 1-10-3 Kuramoto-cho, Tokushima, 770-8539, Japan."), [Ryoei Minato](https://pubmed.ncbi.nlm.nih.gov/?term=Minato+R&cauthor_id=42920004)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#short-view-affiliation-5 "Department of Urology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan."), [Kei Daizumoto](https://pubmed.ncbi.nlm.nih.gov/?term=Daizumoto+K&cauthor_id=42920004)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#short-view-affiliation-5 "Department of Urology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan."), [Kazuyoshi Izumi](https://pubmed.ncbi.nlm.nih.gov/?term=Izumi+K&cauthor_id=42920004)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#short-view-affiliation-3 "Department of Urology, Takamatsu Red Cross Hospital, 4-1-3 Ban-cho, Takamatsu, 760-0017, Japan."), [Tomoya Fukawa](https://pubmed.ncbi.nlm.nih.gov/?term=Fukawa+T&cauthor_id=42920004)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#short-view-affiliation-5 "Department of Urology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan."), [Yutaka Yanagihara](https://pubmed.ncbi.nlm.nih.gov/?term=Yanagihara+Y&cauthor_id=42920004)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#short-view-affiliation-4 "Department of Urology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, 790-0024, Japan."), [Iku Ninomiya](https://pubmed.ncbi.nlm.nih.gov/?term=Ninomiya+I&cauthor_id=42920004)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#short-view-affiliation-4 "Department of Urology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, 790-0024, Japan."), [Ryoichi Nakanishi](https://pubmed.ncbi.nlm.nih.gov/?term=Nakanishi+R&cauthor_id=42920004)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#short-view-affiliation-2 "Department of Urology, Tokushima Prefectural Central Hospital, 1-10-3 Kuramoto-cho, Tokushima, 770-8539, Japan."), [Hirofumi Izaki](https://pubmed.ncbi.nlm.nih.gov/?term=Izaki+H&cauthor_id=42920004)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#short-view-affiliation-2 "Department of Urology, Tokushima Prefectural Central Hospital, 1-10-3 Kuramoto-cho, Tokushima, 770-8539, Japan."), [Masahito Yamanaka](https://pubmed.ncbi.nlm.nih.gov/?term=Yamanaka+M&cauthor_id=42920004)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#short-view-affiliation-3 "Department of Urology, Takamatsu Red Cross Hospital, 4-1-3 Ban-cho, Takamatsu, 760-0017, Japan."), [Kenjiro Okamoto](https://pubmed.ncbi.nlm.nih.gov/?term=Okamoto+K&cauthor_id=42920004)[ 4 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#short-view-affiliation-4 "Department of Urology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, 790-0024, Japan."), [Junya Furukawa](https://pubmed.ncbi.nlm.nih.gov/?term=Furukawa+J&cauthor_id=42920004)[ 5 ](https://pubmed.ncbi.nlm.nih.gov/42920004/#short-view-affiliation-5 "Department of Urology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan.") ### Affiliations * 1 Department of Urology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan. yutaro_sasaki@tokushima-u.ac.jp. * 2 Department of Urology, Tokushima Prefectural Central Hospital, 1-10-3 Kuramoto-cho, Tokushima, 770-8539, Japan. * 3 Department of Urology, Takamatsu Red Cross Hospital, 4-1-3 Ban-cho, Takamatsu, 760-0017, Japan. * 4 Department of Urology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, 790-0024, Japan. * 5 Department of Urology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan. * PMID: **42920004** * DOI: [ 10.1007/s11701-026-04107-9 ](https://doi.org/10.1007/s11701-026-04107-9) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID Linked Discoveries ## Abstract To describe the implementation of robot-assisted radical cystectomy (RARC) at four Japanese institutions, focusing on perioperative outcomes, major complications (Clavien-Dindo grade ≥3), and all-cause mortality within 90 days. We retrospectively analyzed 519 consecutive RARCs for bladder cancer (October 2014-March 2026). Each institution's series was divided chronologically into early (n = 261) and late (n = 258) halves to describe changes in practice (exploratory). Factors associated with major complications were assessed by logistic regression including institution. Survival among 90-day survivors (landmark analysis) was a secondary, exploratory outcome analyzed with Cox models stratified by institution. Within 90 days, 64 patients (12.3%) had a major complication (early 14.6% vs. late 10.1%; adjusted odds ratio 0.67 (95% CI 0.39-1.14)), and 13 (2.5%) died from any cause; six deaths (1.2%) were classified as complication-related. Patients who died were older and had poorer performance status. Pelvic lymph node dissection decreased from 95.4% to 83.3% (pNx, 4.6% to 16.7%), mainly at one institution, and pT3-4 disease decreased from 35.8% to 23.8%. Among 90-day survivors, the late phase was not significantly associated with overall survival (hazard ratio 0.70, 95% CI 0.45 to 1.08), cancer-specific survival (0.65), or recurrence-free survival (0.74), and major complications were not associated with survival. In this multicenter series, about one in eight patients had a major complication and 2.5% died within 90 days. Differences between the early and late groups in tumor characteristics, lymph node dissection, and follow-up preclude attributing any difference in outcomes to surgical experience. **Keywords:** Bladder cancer; Complications; Mortality; Multicenter study; Perioperative outcomes; Robot-assisted radical cystectomy. © 2026. The Author(s), under exclusive licence to Springer-Verlag Londo
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