G Gandaglia1, A Karl2, G Novara3, R de Groote4, A Buchner2, F D'Hondt4, F Montorsi5, C Stief2, A Mottrie6, C Gratzke7. 1. Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium; OLV Vattikuti Robotic Surgery Institute, Melle, Belgium; Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy. Electronic address: giorgio.gandaglia@gmail.com. 2. Department of Urology, LMU Munich, Munich, Germany. 3. OLV Vattikuti Robotic Surgery Institute, Melle, Belgium; Department of Surgery, Oncology, and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy. 4. Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium. 5. Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy. 6. Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium; OLV Vattikuti Robotic Surgery Institute, Melle, Belgium. 7. Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium; Department of Urology, LMU Munich, Munich, Germany.
Abstract
OBJECTIVES: To examine perioperative and oncologic outcomes of open (ORC) and robot-assisted radical cystectomy (RARC) in bladder cancer (BCa) patients. METHODS AND MATERIALS: 368 consecutive patients with cT1-4 M0 BCa treated at two high-volume European centers between 2004 and 2013 were evaluated. Data on complications, operative time, blood loss, postoperative transfusion, reoperation, length of stay (LOS), positive margins, recurrence, cancer-specific mortality (CSM), and overall survival were evaluated. Uni- and multivariable regression analyses tested the impact of the surgical approach on perioperative and oncologic outcomes. RESULTS: Overall, 230 (62.5%) and 138 (37.5%) patients were treated with ORC and RARC. In multivariable analyses RARC patients had higher odds of prolonged operative time and low-grade complications (all P ≤ 0.001). Patients treated with ORC had higher odds of blood loss >500 ml and prolonged LOS (all P ≤ 0.03). No differences were observed in high-grade complications and positive margins (all P ≥ 0.06). No differences were observed in 5-year recurrence-free and CSM-free survival rates between patients treated with ORC vs. RARC (57.1 vs. 54.2% and 61.9 vs. 73.5%; all P ≥ 0.3). This was confirmed in multivariable analyses, where the surgical approach was not associated with the risk of recurrence and CSM (all P ≥ 0.1). CONCLUSIONS: Although ORC might be associated with a shorter operative time, RARC led to lower blood loss and shorter LOS. No differences exist in high-grade complications and positive margins. RARC and ORC provide similar oncologic control.
OBJECTIVES: To examine perioperative and oncologic outcomes of open (ORC) and robot-assisted radical cystectomy (RARC) in bladder cancer (BCa) patients. METHODS AND MATERIALS: 368 consecutive patients with cT1-4 M0 BCa treated at two high-volume European centers between 2004 and 2013 were evaluated. Data on complications, operative time, blood loss, postoperative transfusion, reoperation, length of stay (LOS), positive margins, recurrence, cancer-specific mortality (CSM), and overall survival were evaluated. Uni- and multivariable regression analyses tested the impact of the surgical approach on perioperative and oncologic outcomes. RESULTS: Overall, 230 (62.5%) and 138 (37.5%) patients were treated with ORC and RARC. In multivariable analyses RARC patients had higher odds of prolonged operative time and low-grade complications (all P ≤ 0.001). Patients treated with ORC had higher odds of blood loss >500 ml and prolonged LOS (all P ≤ 0.03). No differences were observed in high-grade complications and positive margins (all P ≥ 0.06). No differences were observed in 5-year recurrence-free and CSM-free survival rates between patients treated with ORC vs. RARC (57.1 vs. 54.2% and 61.9 vs. 73.5%; all P ≥ 0.3). This was confirmed in multivariable analyses, where the surgical approach was not associated with the risk of recurrence and CSM (all P ≥ 0.1). CONCLUSIONS: Although ORC might be associated with a shorter operative time, RARC led to lower blood loss and shorter LOS. No differences exist in high-grade complications and positive margins. RARC and ORC provide similar oncologic control.
Authors: Takehiro Iwata; Shoji Kimura; Beat Foerster; Nicola Fossati; Alberto Briganti; Pierre I Karakiewicz; Kilian M Gust; Shin Egawa; Yasutomo Nasu; Mohammad Abufaraj; Shahrokh F Shariat Journal: World J Urol Date: 2019-04-11 Impact factor: 4.226
Authors: Vivek Venkatramani; Isildinha M Reis; Erik P Castle; Mark L Gonzalgo; Michael E Woods; Robert S Svatek; Alon Z Weizer; Badrinath R Konety; Mathew Tollefson; Tracey L Krupski; Norm D Smith; Ahmad Shabsigh; Daniel A Barocas; Marcus L Quek; Atreya Dash; Adam S Kibel; Raj S Pruthi; Jeffrey Scott Montgomery; Christopher J Weight; David S Sharp; Sam S Chang; Michael S Cookson; Gopal N Gupta; Alex Gorbonos; Edward M Uchio; Eila Skinner; Nachiketh Soodana-Prakash; Maria F Becerra; Sanjaya Swain; Kerri Kendrick; Joseph A Smith; Ian M Thompson; Dipen J Parekh Journal: J Urol Date: 2019-09-24 Impact factor: 7.450
Authors: M Grabbert; T Grimm; A Buchner; A Kretschmer; M Apfelbeck; G Schulz; F Jokisch; B-S Schneevoigt; C G Stief; A Karl Journal: Int Urol Nephrol Date: 2017-09-12 Impact factor: 2.370
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