Analysis of open and intracorporeal robotic assisted radical cystectomy shows no significant difference in recurrence patterns and oncological outcomes

Wei Shen Tan; Ashwin Sridhar; Gidon Ellis; Benjamin Lamb; Miles Goldstraw; Senthil Nathan; John Hines; Paul Cathcart; Tim Briggs; John Kelly

doi:10.1016/j.urolonc.2016.02.010

Analysis of open and intracorporeal robotic assisted radical cystectomy shows no significant difference in recurrence patterns and oncological outcomes

Urol Oncol. 2016 Jun;34(6):257.e1-9. doi: 10.1016/j.urolonc.2016.02.010. Epub 2016 Mar 8.

Authors

Affiliations

¹ Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK. Electronic address: wei.tan@ucl.ac.uk.
² Department of Urology, University College London Hospital, London, UK.
³ Department of Urology, Chase Farm & Barnet Hospitals, London, UK.
⁴ Department of Urology, University College London Hospital, London, UK; Department of Urology, Chase Farm & Barnet Hospitals, London, UK.
⁵ Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK.

PMID: 26968561
DOI: 10.1016/j.urolonc.2016.02.010

Abstract

Objectives: To report and compare early oncological outcomes and cancer recurrence sites among patients undergoing open radical cystectomy (ORC) and robotic-assisted radical cystectomy with intracorporeal urinary diversion (iRARC).

Methods and materials: A total of 184 patients underwent radical cystectomy for bladder cancer. ORC cases (n = 94) were performed between June 2005 and July 2014 while iRARC cases (n = 90) were performed between June 2011 and July 2014. Primary outcome was recurrence free survival (RFS). Secondary outcomes were sites of local and metastatic recurrence, cancer specific survival (CSS) and overall survival (OS).

Results: Median follow-up for patients without recurrence was 33.8 months (interquartile range [IQR]: 20.5-45.4) for ORC; and 16.1 months (IQR: 11.2-27.0) for iRARC. No significant difference in age, sex, precystectomy T stage, precystectomy grade, or lymph node yield between ORC and iRARC was observed. The ORC cohort included more patients with≥pT2 (64.8% ORC vs. 38.9% iRARC) but fewer pT0 status (8.5% ORC vs.vs. 22.2% iRARC) due to lower preoperative chemotherapy use (22.3% ORC vs. 34.4% iRARC). Positive surgical margin rate was significantly higher in the ORC cohort (19.3% vs. 8.2%; P = 0.042). Kaplan-Meir analysis showed no significant difference in RFS (69.5% ORC vs. 78.8% iRARC), cancer specific survival (80.9% ORC vs. 84.4% iRARC), or OS (73.5% ORC vs.vs. iRARC 83.8%) at 24 months. Cox regression analysis showed RFS, cancer specific survival and OS were not influenced by cystectomy technique. No significant difference between local and metastatic RFS between ORC and iRARC was observed.

Conclusion: This study has found no difference in recurrence patterns or oncological outcomes between ORC and iRARC. Recurrent metastatic sites vary, but are not related to surgical technique.

Keywords: Bladder cancer; Intracorporeal urinary diversion; Open cystectomy; Outcomes; Recurrence; Robotic-assisted cystectomy.

Publication types

Comparative Study

MeSH terms

Aged
Cystectomy / methods*
Female
Humans
Male
Middle Aged
Neoplasm Recurrence, Local
Retrospective Studies
Robotic Surgical Procedures*
Treatment Outcome
Urinary Bladder Neoplasms / surgery*