OBJECTIVE: • To determine oncological outcomes including early survival rates among unselected bladder urothelial carcinoma (BUC) patients treated with robotic-assisted radical cystectomy (RRC). PATIENTS AND METHODS: • Clinicopathologic and survival data were prospectively gathered for 85 consecutive BUC patients treated with RRC. • The decision to undergo a robotic rather than open approach was made without regard to tumor volume or surgical candidacy. • Kaplan-Meier survival rates were determined and stratified by tumor stage and LN positivity, and multivariate analysis was performed to identify independent predictors of survival. RESULTS: • Patients were relatively old (25% >80 years; median 73.5 years), with frequent comorbidities (46% with ASA class ≥ 3). Of these patients 28% had undergone previous pelvic radiation or pelvic surgery, and 20% had received neoadjuvant chemotherapy. • Extended pelvic lymphadenectomy was performed in 98% of patients, with on average 19.1 LN retrieved. • On final pathology, extravesical disease was common (36.5%). • Positive surgicalmargins were detected in five (6%) patients, all of whom had extravesical tumors with perineural and/or lymphovascular invasion, and most of whom were >80 years old. • At a mean postoperative interval of 18 months, 20 (24%) patients had developed recurrent disease, but only three (4%) patients had recurrence locally. Disease-free, cancer-specific and overall survival rates at 2 years were 74%, 85% and 79%, respectively. Patients with low-stage/LN(-) cancers had significantly better survival than extravesical/LN(-) or any-stage/LN(+) patients, with stage being the most important predictor on multivariate analysis. CONCLUSION: • RRC can achieve adequately high LN yields with a low positive margin rate among unselected BUC patients. • Early survival outcomes are similar to those reported in contemporary open series, with an encouragingly low incidence of local recurrence, however long-term follow-up and head-to-head comparison with the open approach are still needed.
OBJECTIVE: • To determine oncological outcomes including early survival rates among unselected bladder urothelial carcinoma (BUC) patients treated with robotic-assisted radical cystectomy (RRC). PATIENTS AND METHODS: • Clinicopathologic and survival data were prospectively gathered for 85 consecutive BUC patients treated with RRC. • The decision to undergo a robotic rather than open approach was made without regard to tumor volume or surgical candidacy. • Kaplan-Meier survival rates were determined and stratified by tumor stage and LN positivity, and multivariate analysis was performed to identify independent predictors of survival. RESULTS: • Patients were relatively old (25% >80 years; median 73.5 years), with frequent comorbidities (46% with ASA class ≥ 3). Of these patients 28% had undergone previous pelvic radiation or pelvic surgery, and 20% had received neoadjuvant chemotherapy. • Extended pelvic lymphadenectomy was performed in 98% of patients, with on average 19.1 LN retrieved. • On final pathology, extravesical disease was common (36.5%). • Positive surgicalmargins were detected in five (6%) patients, all of whom had extravesical tumors with perineural and/or lymphovascular invasion, and most of whom were >80 years old. • At a mean postoperative interval of 18 months, 20 (24%) patients had developed recurrent disease, but only three (4%) patients had recurrence locally. Disease-free, cancer-specific and overall survival rates at 2 years were 74%, 85% and 79%, respectively. Patients with low-stage/LN(-) cancers had significantly better survival than extravesical/LN(-) or any-stage/LN(+) patients, with stage being the most important predictor on multivariate analysis. CONCLUSION: • RRC can achieve adequately high LN yields with a low positive margin rate among unselected BUC patients. • Early survival outcomes are similar to those reported in contemporary open series, with an encouragingly low incidence of local recurrence, however long-term follow-up and head-to-head comparison with the open approach are still needed.
Authors: Alvin C Goh; Monty A Aghazadeh; Ross E Krasnow; Alexander W Pastuszak; Julie N Stewart; Brian J Miles Journal: J Endourol Date: 2015-02-05 Impact factor: 2.942
Authors: Ali Al-Daghmin; Eric C Kauffman; Yi Shi; Ketan Badani; M Derya Balbay; Erdem Canda; Prokar Dasgupta; Reza Ghavamian; Robert Grubb; Ashok Hemal; Jihad Kaouk; Adam S Kibel; Thomas Maatman; Mani Menon; Alex Mottrie; Kenneth Nepple; John G Pattaras; James O Peabody; Vassilis Poulakis; Raj Pruthi; Juan Palou Redorta; Koon-Ho Rha; Lee Richstone; Francis Schanne; Douglas S Scherr; Stefan Siemer; Michael Stöckle; Eric M Wallen; Alon Weizer; Peter Wiklund; Timothy Wilson; Gregory Wilding; Michael Woods; Khurshid A Guru Journal: BJU Int Date: 2014-05-22 Impact factor: 5.588
Authors: Susan J Marshall; Matthew H Hayn; Andrew P Stegemann; Piyush K Agarwal; Ketan K Badani; M Derya Balbay; Prokar Dasgupta; Ashok K Hemal; Brent K Hollenbeck; Adam S Kibel; Mani Menon; Alex Mottrie; Kenneth Nepple; John G Pattaras; James O Peabody; Vassilis Poulakis; Raj S Pruthi; Joan Palou Redorta; Koon-Ho Rha; Lee Richstone; Francis Schanne; Douglas S Scherr; Stefan Siemer; Michael Stöckle; Eric M Wallen; Alon Z Weizer; Peter Wiklund; Timothy Wilson; Michael Woods; Khurshid A Guru Journal: BJU Int Date: 2013-02-26 Impact factor: 5.588