Atypical oncologic failure after laparoscopic and robot-assisted radical cystectomy at a single institution

• Published in: International journal of clinical oncology Vol. 25; no. 7; pp. 1385 - 1392
• Main Authors: Kubota, Masashi, Kokubun, Hidetoshi, Yamaguchi, Ritsuki, Murata, Shiori, Makita, Noriyuki, Suzuki, Issei, Suzuki, Ryosuke, Abe, Yohei, Tohi, Yoichiro, Tsutsumi, Naofumi, Sugino, Yoshio, Inoue, Koji, Kawakita, Mutsushi
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01.07.2020; Springer Nature B.V
• Subjects: Bladder cancer; Cancer Research; Gastric cancer; Laparoscopy; Medicine; Medicine & Public Health; Oncology; Original Article; Peritoneum; Robotic surgery; Robots; Surgical Oncology; Urothelial carcinoma; Port site; Recurrence; Cystectomy; Bladder cancer; Peritoneal carcinomatosis
• ISSN: 1341-9625; 1437-7772
• DOI: 10.1007/s10147-020-01677-y

Background The incidence of atypical oncologic failure in patients with bladder cancer, including peritoneal carcinomatosis, and recurrences at the port site and soft tissue after laparoscopic and robot-assisted radical cystectomy are not well characterized. Methods We retrospectively reviewed the records of 52, 51, and 12 patients who underwent open, laparoscopic, and robot-assisted radical cystectomy, respectively, for bladder cancer from 2007 to 2018 at our institution. We identified techniques associated with atypical oncologic failure. Results The median follow-up period was 29 months. Among the 115 patients, 29 (25%) experienced oncological recurrences, and 7 (6%), 12 (10%), and 23 (20%) had atypical, local, and distant recurrences, respectively. The laparoscopic and robot-assisted radical cystectomy groups had significantly higher incidences of total atypical oncologic failure than the open radical cystectomy group ( p  = 0.013), including six, one, and two patients with peritoneal carcinomatosis, port site carcinomatosis, and soft tissue involvement, respectively. All 7 patients with atypical oncologic failure died of cancer; the median time from surgery to death was 9.3 months. All these patients were cT ≧ 3 and had grade 3 disease. In three patients (43%), the pathological tissue contained variants other than urothelial carcinoma. Five (71%) were among the initial twenty patients. Four patients (57%) had histories of intraoperative urine spillage or bladder perforation during transurethral resection. Conclusions Patients with cT ≧ 3 stage, with pathological variants other than urothelial carcinoma, and those undergoing procedures that lead to extravesical dissemination should avoid laparoscopic radical cystectomy when the procedures are first introduced.