Long-term Oncologic Outcomes Following Robot-assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium

• Published in: European urology Vol. 68; no. 4; pp. 721 - 728
• Main Authors: Raza, Syed Johar, Wilson, Timothy, Peabody, James O, Wiklund, Peter, Scherr, Douglas S, Al-Daghmin, Ali, Dibaj, Shiva, Khan, Muhammad Shamim, Dasgupta, Prokar, Mottrie, Alex, Menon, Mani, Yuh, Bertram, Richstone, Lee, Saar, Matthias, Stoeckle, Michael, Hosseini, Abolfazl, Kaouk, Jihad, Mohler, James L, Rha, Koon-Ho, Wilding, Gregory, Guru, Khurshid A
• Format: Journal Article
• Language: English
• Published: Switzerland Elsevier B.V 01.10.2015
• Subjects: Aged; Bladder cancer; Chemotherapy, Adjuvant; Cystectomy - adverse effects; Cystectomy - methods; Cystectomy - mortality; Databases, Factual; Disease-Free Survival; Female; Humans; Kaplan-Meier Estimate; Male; Medicin och hälsovetenskap; Middle Aged; Neoplasm Recurrence, Local; Outcomes; Proportional Hazards Models; Radical cystectomy; Recurrence; Retrospective Studies; Risk Factors; Robot-assisted; Robotic; Robotic Surgical Procedures - adverse effects; Robotic Surgical Procedures - mortality; Survival; Time Factors; Treatment Outcome; Urinary Bladder Neoplasms - mortality; Urinary Bladder Neoplasms - pathology; Urinary Bladder Neoplasms - surgery; Urology; Recurrence; Robot-assisted; Robotic; Radical cystectomy; Survival; Bladder cancer; Outcomes
• ISSN: 0302-2838; 1873-7560; 1873-7560
• DOI: 10.1016/j.eururo.2015.04.021

Abstract Background Long-term oncologic data on patients undergoing robot-assisted radical cystectomy (RARC) are limited and based largely on single-institution series. Objective Report survival outcomes of patients who underwent RARC ≥5 yr ago. Design, setting, and participants Retrospective review of the prospectively populated International Robotic Cystectomy Consortium multi-institutional database identified 743 patients with RARC performed ≥5 yr ago. Clinical, pathologic, and survival data at the latest follow-up were collected. Patients with palliative RARC were excluded. Final analysis was performed on 702 patients from 11 institutions in 6 countries. Intervention RARC. Outcome measurements and statistical analysis Outcomes of interest, recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were plotted using Kaplan-Meier survival curves. A Cox proportional hazards model was used to identify factors that predicted outcomes. Results and limitations Pathologic organ-confined (OC) disease was found in 62% of patients. Soft tissue surgical margins (SMs) were positive in 8%. Median lymph node (LN) yield was 16, and 21% of patients had positive LNs. Median follow-up was 67 mo (interquartile range: 18–84 mo). Five-year RFS, CSS, and OS were 67%, 75%, and 50%, respectively. Non-OC disease and SMs were associated with poorer RFS, CSS, and OS on multivariable analysis. Age predicted poorer CSS and OS. Adjuvant chemotherapy and positive SMs were predictors of RFS (hazard ratio: 3.20 and 2.16; p < 0.001 and p < 0.005, respectively). Stratified survival curves demonstrated poorer outcomes for positive SM, LN, and non-OC disease. Retrospective interrogation and lack of contemporaneous comparison groups that underwent open radical cystectomy were major limitations. Conclusions The largest multi-institutional series to date reported long-term survival outcomes after RARC. Patient summary Patients who underwent robot-assisted radical cystectomy for bladder cancer have acceptable long-term survival.