Syed Johar Raza1, Ali Al-Daghmin1, Sharon Zhuo1, Zayn Mehboob1, Katy Wang2, Gregory Wilding2, Eric Kauffman3, Khurshid A Guru4. 1. Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA. 2. Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY, USA. 3. Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA; Department of Cancer Genetics, Roswell Park Cancer Institute, Buffalo, NY, USA. 4. Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA. Electronic address: khurshid.guru@roswellpark.org.
Abstract
BACKGROUND: Long-term oncologic outcomes following robot-assisted radical cystectomy (RARC) remain scarce. OBJECTIVE: To report long-term oncologic outcomes following RARC at a single institution. DESIGN, SETTINGS, AND PARTICIPANTS: Retrospective review of 99 patients who underwent RARC for urothelial carcinoma of bladder between 2005 and 2009. INTERVENTION: RARC was performed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Primary outcomes included recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS), measured by the Kaplan-Meier method. The association between primary outcomes and perioperative and pathologic factors was assessed using a multivariable Cox proportional hazards model. RESULTS AND LIMITATIONS: Fifty-one (52%) patients had stage pT3 or higher disease. Eight (8%) patients had positive margins and 30 (30%) had positive lymph nodes (LNs), with a median of 21 LNs removed. Median follow-up for patients alive was 74 mo. The 5-yr RFS, CSS, and OS rates were 52.5%, 67.8%, and 42.4%, respectively. Tumor stage, LN stage, and margin status were each significantly associated with RFS, CSS, and OS. On multivariable analysis, tumor and LN stage were independent predictors of RFS, CSS, and OS, while positive margin status and Charlson comorbidity index predicted worse OS and CSS. Adjuvant chemotherapy predicted RFS only. Retrospective design and lack of open comparison are main limitations of this study. CONCLUSIONS: Long-term oncologic outcomes following RARC demonstrate RFS and CSS estimates similar to those reported in literature for open radical cystectomy. Randomized controlled trials can better define outcomes of any alternative technique. PATIENT SUMMARY: Survival data 5 yr after RARC for bladder cancer demonstrate that survival outcomes are dependent on the same oncologic parameters as previously reported for open surgery.
BACKGROUND: Long-term oncologic outcomes following robot-assisted radical cystectomy (RARC) remain scarce. OBJECTIVE: To report long-term oncologic outcomes following RARC at a single institution. DESIGN, SETTINGS, AND PARTICIPANTS: Retrospective review of 99 patients who underwent RARC for urothelial carcinoma of bladder between 2005 and 2009. INTERVENTION: RARC was performed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Primary outcomes included recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS), measured by the Kaplan-Meier method. The association between primary outcomes and perioperative and pathologic factors was assessed using a multivariable Cox proportional hazards model. RESULTS AND LIMITATIONS: Fifty-one (52%) patients had stage pT3 or higher disease. Eight (8%) patients had positive margins and 30 (30%) had positive lymph nodes (LNs), with a median of 21 LNs removed. Median follow-up for patients alive was 74 mo. The 5-yr RFS, CSS, and OS rates were 52.5%, 67.8%, and 42.4%, respectively. Tumor stage, LN stage, and margin status were each significantly associated with RFS, CSS, and OS. On multivariable analysis, tumor and LN stage were independent predictors of RFS, CSS, and OS, while positive margin status and Charlson comorbidity index predicted worse OS and CSS. Adjuvant chemotherapy predicted RFS only. Retrospective design and lack of open comparison are main limitations of this study. CONCLUSIONS: Long-term oncologic outcomes following RARC demonstrate RFS and CSS estimates similar to those reported in literature for open radical cystectomy. Randomized controlled trials can better define outcomes of any alternative technique. PATIENT SUMMARY: Survival data 5 yr after RARC for bladder cancer demonstrate that survival outcomes are dependent on the same oncologic parameters as previously reported for open surgery.
Authors: Bernard H Bochner; Guido Dalbagni; Karim H Marzouk; Daniel D Sjoberg; Justin Lee; Sheri M Donat; Jonathan A Coleman; Andrew Vickers; Harry W Herr; Vincent P Laudone Journal: Eur Urol Date: 2018-05-18 Impact factor: 20.096
Authors: Jeffrey J Leow; Jens Bedke; Karim Chamie; Justin W Collins; Siamak Daneshmand; Petros Grivas; Axel Heidenreich; Edward M Messing; Trevor J Royce; Alexander I Sankin; Mark P Schoenberg; William U Shipley; Arnauld Villers; Jason A Efstathiou; Joaquim Bellmunt; Arnulf Stenzl Journal: World J Urol Date: 2019-01-25 Impact factor: 4.226