ABSTRACT Purpose: To evaluate the potential oncologic benefit of a visibly complete transurethral resection of a bladder tumor (TURBT) prior to neoadjuvant chemotherapy (NAC) and radical cystectomy (RC). Materials and Methods: We identified patients who received NAC and RC between 2011-2021. Records were reviewed to assess TURBT completeness. The primary outcome was pathologic downstaging (<ypT2N0), with complete pathologic response (ypT0N0) and survival as secondary endpoints. Logistic regression and Cox proportional hazards models were utilized. Results: We identified 153 patients, including 116 (76%) with a complete TURBT. Sixty-four (42%) achieved <ypT2N0 and 43 (28%) achieved ypT0N0. When comparing those with and without a complete TURBT, there was no significant difference in the proportion with <ypT2N0 (43% vs 38%, P=0.57) or ypT0N0 (28% vs 27%, P=0.87). After median follow-up of 3.6 years (IQR 1.5-5.1), 86 patients died, 37 died from bladder cancer, and 61 had recurrence. We did not observe a statistically significant association of complete TURBT with cancer-specific or recurrence-free survival (p≥0.20), although the hazard of death from any cause was significantly higher among those with incomplete TURBT even after adjusting for ECOG and pathologic T stage, HR 1.77 (95% CI 1.04-3.00, P=.034). Conclusions: A visibly complete TURBT was not associated with pathologic downstaging, cancer-specific or recurrence-free survival following NAC and RC. These data do not support the need for repeat TURBT to achieve a visibly complete resection if NAC and RC are planned. Purpose (TURBT (NAC . (RC) Methods 20112021. 20112021 2011 2021. 2021 2011-2021 completeness <ypT2N0, ypT2N0 ypTN , ypT N (<ypT2N0) (ypT0N0 endpoints utilized Results 15 11 76% 76 (76% Sixtyfour Sixty four 42% 42 (42% <ypT2N 4 28% 28 43% (43 38 38% P=0.57 P057 P 0 57 ypT0N (28 27 27% P=0.87. P087 P=0.87 87 P=0.87) followup follow up 36 3 6 3. IQR 1.55.1, 1551 1.5 5.1 1 5 1.5-5.1) 8 cancer recurrence cancerspecific specific recurrencefree free p≥0.20, p020 p p≥0.20 20 (p≥0.20) stage 177 77 1.7 95% 95 (95 1.043.00, 104300 1.04 3.00, 04 00 1.04-3.00 P=.034. P034 P=.034 034 P=.034) Conclusions planned (RC 2011202 201 202 2011-202 ypT2N (<ypT2N0 (ypT0N 7 (76 (42 2 (4 P=0.5 P05 (2 P08 P=0.8 55 1.55.1 155 1. 51 5. 1.5-5.1 p02 p≥0.2 (p≥0.20 17 9 (9 043 1.043.00 10430 104 1.0 300 3.00 1.04-3.0 P03 P=.03 03 201120 2011-20 (<ypT2N (7 ( P=0. P0 1.55. 1.5-5. p0 p≥0. (p≥0.2 1.043.0 1043 10 30 3.0 1.04-3. P=.0 20112 2011-2 P=0 1.55 1.5-5 p≥0 (p≥0. 1.043. 1.04-3 P=. 2011- P= 1.5- p≥ (p≥0 1.043 1.04- (p≥ (p

ABSTRACT Purpose: To prospectively evaluate the association of adherent perinephric fat (APF) on perioperative outcomes of robotic-assisted partial nephrectomy (RAPN) following elimination of the surgical learning curve. Materials and Methods: 305 consecutive RAPNs performed by a single experienced surgeon were analyzed. The first 100 RAPNs were considered the learning curve and therefore excluded. APF was defined as the necessity of subcapsular renal dissection to mobilize the tumor from surrounding perinephric fat. Perioperative outcomes were evaluated including operative time, warm ischemia time (WIT), postoperative complications, length of stay, margins, ischemia, and complications score (MIC), estimated blood loss (EBL), and change in pre-operative to postoperative day 1 (POD 1) laboratory values. After correction for multiple comparisons, P values ≤0.0045 were considered statistically significant but associations with P values ≤0.05 were also mentioned in the study results. Results: Fifty-eight (28.3%) patients had APF. Patients with APF had longer operative times compared to those without APF (median, 213 vs. 192 minutes, P <0.001). There was some evidence of higher increase in change in creatinine from preoperative to POD 1 among those with APF compared to those without APF, although this was not statistically significant (median, 0.2 vs. 0.1mg/dL, P=0.03). There were no other statistically significant associations between presence of APF and perioperative outcomes. Conclusions: APF is associated with increased operative time but no change in other perioperative outcomes. Surgeon experience does not affect perioperative outcomes associated with APF.