TY - JOUR
T1 - Long-term oncologic outcomes of robot-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion (ICUD)
T2 - a multi-center study
AU - Brassetti, Aldo
AU - Cacciamani, Giovanni
AU - Anceschi, Umberto
AU - Ferriero, Mariaconsiglia
AU - Tuderti, Gabriele
AU - Miranda, Gus
AU - Mastroianni, Riccardo
AU - Desai, Mihir
AU - Aron, Monish
AU - Gill, Inderbir
AU - Gallucci, Michele
AU - Simone, Giuseppe
PY - 2019/1/1
Y1 - 2019/1/1
N2 - Purpose: To report survival outcomes after robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) for recurrent/muscle-invasive non-metastatic bladder cancer. Methods: Prospectively maintained databases were queried for “robotic cystectomy AND ICUD”. Patients treated after October 2013 and those treated without curative intent were excluded. Kaplan–Meier method was used to plot stage-specific survival outcomes, computed at 1, 2, and 5 years after surgery. Univariable and multivariable Cox analyses assessed predictors of recurrence-free (RFS), cancer-specific (CSS) and overall (OS) survival. Results: 113 consecutive patients were included, mostly men (82%). Neoadjuvant chemotherapy was performed in 23% of cases, median lymph node (LN) yield was 36 (IQR 28–45) and the rate of positive surgical margins (PSM) was 8%. Orthotopic ileal neobladder was the preferred ICUD type (57%). An organ-confined disease was observed in 51% of cases and 21% were pT0 on final histology. Overall, 5-year RFS, CSS and OS probabilities were 58 ± 5%, 61 ± 5% and 54 ± 5%, respectively. At Kaplan–Meier method, tumor stage group was a significant predictor of survival probabilities (all p < 0.001) and this was confirmed at multivariable Cox regression analysis (RFS-OR 2.29; 95% CI 1.58–3.32; p < 0.001) (CSS-OR 1.82; 95% CI 1.3–2.53; p < 0.001) (OS-OR 2.14; 95% CI 1.46–3.14; p < 0.001). PSM status was associated to CSS (OR 2.54; 95% CI 1.13–5.69; p = 0.024) and OS (OR 2.82; 95% CI 1.17–6.77; p = 0.021), but did not predict RFS (p = 0.062). Conclusions: Long-term oncologic outcomes after RARC with ICUD appear similar to recent robotic series with extracorporeal diversion and historical open experiences.
AB - Purpose: To report survival outcomes after robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) for recurrent/muscle-invasive non-metastatic bladder cancer. Methods: Prospectively maintained databases were queried for “robotic cystectomy AND ICUD”. Patients treated after October 2013 and those treated without curative intent were excluded. Kaplan–Meier method was used to plot stage-specific survival outcomes, computed at 1, 2, and 5 years after surgery. Univariable and multivariable Cox analyses assessed predictors of recurrence-free (RFS), cancer-specific (CSS) and overall (OS) survival. Results: 113 consecutive patients were included, mostly men (82%). Neoadjuvant chemotherapy was performed in 23% of cases, median lymph node (LN) yield was 36 (IQR 28–45) and the rate of positive surgical margins (PSM) was 8%. Orthotopic ileal neobladder was the preferred ICUD type (57%). An organ-confined disease was observed in 51% of cases and 21% were pT0 on final histology. Overall, 5-year RFS, CSS and OS probabilities were 58 ± 5%, 61 ± 5% and 54 ± 5%, respectively. At Kaplan–Meier method, tumor stage group was a significant predictor of survival probabilities (all p < 0.001) and this was confirmed at multivariable Cox regression analysis (RFS-OR 2.29; 95% CI 1.58–3.32; p < 0.001) (CSS-OR 1.82; 95% CI 1.3–2.53; p < 0.001) (OS-OR 2.14; 95% CI 1.46–3.14; p < 0.001). PSM status was associated to CSS (OR 2.54; 95% CI 1.13–5.69; p = 0.024) and OS (OR 2.82; 95% CI 1.17–6.77; p = 0.021), but did not predict RFS (p = 0.062). Conclusions: Long-term oncologic outcomes after RARC with ICUD appear similar to recent robotic series with extracorporeal diversion and historical open experiences.
KW - Bladder cancer
KW - Long-term outcomes
KW - Radical cystectomy
KW - Robotic
KW - Survival
KW - Urothelial carcinoma
UR - http://www.scopus.com/inward/record.url?scp=85067389605&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85067389605&partnerID=8YFLogxK
U2 - 10.1007/s00345-019-02842-3
DO - 10.1007/s00345-019-02842-3
M3 - Article
AN - SCOPUS:85067389605
JO - World Journal of Urology
JF - World Journal of Urology
SN - 0724-4983
ER -