Wei Shen Tan1, Ashwin Sridhar2, Gidon Ellis3, Benjamin Lamb2, Miles Goldstraw2, Senthil Nathan2, John Hines2, Paul Cathcart2, Tim Briggs4, John Kelly5. 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.
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.
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.
Authors: Bhavan Prasad Rai; Jasper Bondad; Nikhil Vasdev; Jim Adshead; Tim Lane; Kamran Ahmed; Mohammed S Khan; Prokar Dasgupta; Khurshid Guru; Piotr L Chlosta; Omar M Aboumarzouk Journal: Cochrane Database Syst Rev Date: 2019-04-24
Authors: James W F Catto; Pramit Khetrapal; Gareth Ambler; Rachael Sarpong; Muhammad Shamim Khan; Melanie Tan; Andrew Feber; Simon Dixon; Louise Goodwin; Norman R Williams; John McGrath; Edward Rowe; Anthony Koupparis; Chris Brew-Graves; John D Kelly Journal: BMJ Open Date: 2018-08-08 Impact factor: 2.692