Ahmed A Hussein1, Matthias Saar2, Paul R May3, Carl J Wijburg4, Lee Richstone5, Andrew Wagner6, Timothy Wilson7, Bertram Yuh7, Joan Palou Redorta8, Prokar Dasgupta9, Mohammad Shamim Khan9, Mani Menon10, James O Peabody10, Abolfazl Hosseini11, Franco Gaboardi12, Alexandre Mottrie13, Koon-Ho Rha14, Ashok Hemal15, Michael Stockle2, John Kelly16, Thomas J Maatman17, Abdullah Erdem Canda18, Peter Wiklund11, Khurshid A Guru19. 1. Roswell Park Cancer Institute, Buffalo, New York; Cairo University, Cairo, Egypt. 2. University of the Saarland, Homburg, Germany. 3. Roswell Park Cancer Institute, Buffalo, New York. 4. Rijnstate Hospital, Arnhem, the Netherlands. 5. Arthur Smith Institute for Urology, New York, New York. 6. Beth Israel Deaconess Medical Center, Boston, Massachusetts. 7. City of Hope and Beckman Research Institute, Duarte, California. 8. Fundació Puigvert, Barcelona, Spain. 9. Guy's Hospital and King's College, London School of Medicine, London, United Kingdom. 10. Henry Ford Health System, Detroit, Michigan. 11. Karolinska University Hospital, Stockholm, Sweden. 12. Luigi Sacco University Hospital, Milan, Italy. 13. Onze-Lieve-Vrouw Ziekenhuis, Aalast, Belgium. 14. Yonsei University Health System Severance Hospital, Seoul, Korea. 15. Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina. 16. Division of Surgery and Interventional Science, Department of Urology, University College London, London, United Kingdom. 17. Michigan Urological Clinic, Grand Rapids, Michigan. 18. Yildirim Beyazit University, School of Medicine, Ankara Ataturk Training and Research Hospital, Ankara, Turkey. 19. Roswell Park Cancer Institute, Buffalo, New York. Electronic address: Khurshid.guru@roswellpark.org.
Abstract
PURPOSE: We sought to investigate the prevalence and variables associated with early oncologic failure. MATERIALS AND METHODS: We retrospectively reviewed the IRCC (International Radical Cystectomy Consortium) database of patients who underwent robot-assisted radical cystectomy since 2003. The final cohort comprised a total of 1,894 patients from 23 institutions in 11 countries. Early oncologic failure was defined as any disease relapse within 3 months of robot-assisted radical cystectomy. All institutions were surveyed for the pneumoperitoneum pressure used, breach of oncologic surgical principles, and techniques of specimen and lymph node removal. A multivariate model was fit to evaluate predictors of early oncologic failure. The Kaplan-Meier method was applied to depict disease specific and overall survival, and Cox proportional regression analysis was used to evaluate predictors of disease specific and overall survival. RESULTS: A total of 305 patients (22%) experienced disease relapse, which was distant in 220 (16%), local recurrence in 154 (11%), peritoneal carcinomatosis in 17 (1%) and port site recurrence in 5 (0.4%). Early oncologic failure developed in 71 patients (5%) at a total of 10 institutions. The incidence of early oncologic failure decreased from 10% in 2006 to 6% in 2015. On multivariate analysis the presence of any complication (OR 2.87, 95% CI 1.38-5.96, p = 0.004), pT3 or greater disease (OR 3.73, 95% CI 2.00-6.97, p <0.001) and nodal involvement (OR 2.14, 95% CI 1.21-3.80, p = 0.008) was a significant predictor of early oncologic failure. Patients with early oncologic failure demonstrated worse disease specific and overall survival (23% and 13%, respectively) at 1 and 3 years compared to patients who experienced later or no recurrences (log rank p <0.001). CONCLUSIONS: The incidence of early oncologic failure following robot-assisted radical cystectomy has decreased with time. Disease related rather than technical related factors have a major role in early oncologic failure after robot-assisted radical cystectomy.
PURPOSE: We sought to investigate the prevalence and variables associated with early oncologic failure. MATERIALS AND METHODS: We retrospectively reviewed the IRCC (International Radical Cystectomy Consortium) database of patients who underwent robot-assisted radical cystectomy since 2003. The final cohort comprised a total of 1,894 patients from 23 institutions in 11 countries. Early oncologic failure was defined as any disease relapse within 3 months of robot-assisted radical cystectomy. All institutions were surveyed for the pneumoperitoneum pressure used, breach of oncologic surgical principles, and techniques of specimen and lymph node removal. A multivariate model was fit to evaluate predictors of early oncologic failure. The Kaplan-Meier method was applied to depict disease specific and overall survival, and Cox proportional regression analysis was used to evaluate predictors of disease specific and overall survival. RESULTS: A total of 305 patients (22%) experienced disease relapse, which was distant in 220 (16%), local recurrence in 154 (11%), peritoneal carcinomatosis in 17 (1%) and port site recurrence in 5 (0.4%). Early oncologic failure developed in 71 patients (5%) at a total of 10 institutions. The incidence of early oncologic failure decreased from 10% in 2006 to 6% in 2015. On multivariate analysis the presence of any complication (OR 2.87, 95% CI 1.38-5.96, p = 0.004), pT3 or greater disease (OR 3.73, 95% CI 2.00-6.97, p <0.001) and nodal involvement (OR 2.14, 95% CI 1.21-3.80, p = 0.008) was a significant predictor of early oncologic failure. Patients with early oncologic failure demonstrated worse disease specific and overall survival (23% and 13%, respectively) at 1 and 3 years compared to patients who experienced later or no recurrences (log rank p <0.001). CONCLUSIONS: The incidence of early oncologic failure following robot-assisted radical cystectomy has decreased with time. Disease related rather than technical related factors have a major role in early oncologic failure after robot-assisted radical cystectomy.
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: Lei Wei; Ahmed A Hussein; Yingyu Ma; Gissou Azabdaftari; Youssef Ahmed; Lai Ping Wong; Qiang Hu; Wei Luo; Victoria N Cranwell; Brittany L Bunch; Justen D Kozlowski; Prashant K Singh; Sean T Glenn; Gary Smith; Candace S Johnson; Song Liu; Khurshid A Guru Journal: J Urol Date: 2019-06 Impact factor: 7.600
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