Andrea Necchi1, Gregory R Pond2, Marc C Smaldone3, Sumanta K Pal4, Kevin Chan4, Yu-Ning Wong3, Rosalia Viterbo3, Guru Sonpavde5, Lauren C Harshman6, Simon Crabb7, Ajjai Alva8, Simon Chowdhury9, Ugo De Giorgi10, Sandy Srinivas11, Neeraj Agarwal12, Aristotelis Bamias13, Jack Baniel14, Ali-Reza Golshayan15, Sylvain Ladoire16, Cora N Sternberg17, Linda Cerbone17, Evan Y Yu18, Joaquim Bellmunt6, Ulka Vaishampayan19, Gunter Niegisch20, Syed Hussain21, Daniel W Bowles22, Rafael Morales-Barrera23, Matthew I Milowsky24, Christine Theodore25, Dominik R Berthold26, Srikala S Sridhar27, Thomas Powles28, Jonathan E Rosenberg29, Matthew D Galsky30. 1. Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: andrea.necchi@istitutotumori.mi.it. 2. McMaster University, Hamilton, Ontario, Canada. 3. Fox Chase Cancer Center, Philadelphia, PA, USA. 4. City of Hope Comprehensive Cancer Center, Duarte, CA, USA. 5. UAB Comprehensive Cancer Center, Birmingham, AL, USA. 6. Dana Farber Cancer Institute, Boston, MA, USA. 7. University of Southampton, Southampton, UK. 8. University of Michigan, Ann Arbor, MI, USA. 9. Guy's and St. Thomas' Hospital, London, UK. 10. IRCCS Istituto Scientifico Romagnolo per lo studio e la Cura dei Tumori, Meldola, Italy. 11. Stanford University School of Medicine, Stanford, CA, USA. 12. University of Utah, Salt Lake City, UT, USA. 13. University of Athens, Athens, Greece. 14. Rabin Medical Center, Petach Tikva, Israel. 15. Medical University of South Carolina, Charleston, SC, USA. 16. Centre Georges-François Leclerc, Dijon, France. 17. San Camillo Forlanini Hospital, Rome, Italy. 18. University of Washington, Seattle, WA, USA. 19. Karmanos Cancer Institute, Detroit, MI, USA. 20. Heinrich-Heine-University, Düsseldorf, Germany. 21. University of Liverpool, Liverpool, UK. 22. Denver Veterans Affairs Medical Center, Eastern Colorado Health Care System, Denver, CO, USA. 23. Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain. 24. University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, NC, USA. 25. Hopital Foch, Suresnes, France. 26. Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. 27. Princess Margaret Hospital, University Health Network, Toronto, Canada. 28. Barts Health and the Royal Free NHS Trust, Queen Mary University of London, London, UK. 29. Memorial Sloan-Kettering Cancer Center, New York, NY, USA. 30. Mount Sinai School of Medicine, Tisch Cancer Institute, New York, NY, USA.
Abstract
BACKGROUND: Little is known about the outcomes of robot-assisted radical cystectomy (RARC) compared to open radical cystectomy (ORC) combined with perioperative chemotherapy for muscle-invasive urothelial bladder cancer (UBC). OBJECTIVE: To evaluate surgical and oncological outcomes for RARC and ORC in multimodal treatment. DESIGN, SETTING, AND PARTICIPANTS: Data from 28 centres were collected for cystectomies performed between January 2000 and July 2013. INTERVENTION: RARC or ORC combined with perioperative chemotherapy for UBC. OUTCOME MEASURES AND STATISTICAL ANALYSIS: Fisher's exact tests, χ2 tests, and Wilcoxon rank-sum tests were used to compare the RARC and ORC groups. Logistic and Cox regression analyses were performed to evaluate potential prognostic factors. RESULTS AND LIMITATIONS: A total of 688 patients (n=603 ORC and n=85 RARC) were analysed; 60.6% received neoadjuvant chemotherapy, and 45.1% adjuvant chemotherapy. No significant differences in baseline characteristics were found between the groups. The median time from surgery to adjuvant chemotherapy was 1.9 mo for both RARC and ORC groups. The median number of lymph nodes removed was 21 (interquartile range [IQR] 14-35) for RARC and 13 (IQR 8-21) for ORC (p<0.001); the results were confirmed in subgroup analyses. Multivariable analyses revealed no difference in the rate of positive surgical margins (p=0.54 and p=0.78), rate of neobladder diversion (p=0.33 and p=0.51), relapse-free survival (p=0.31 and p=0.23), and overall survival (p=0.63 and p=0.69). The retrospective nature of the data is the major limitation. CONCLUSIONS: In this study, no differences in efficacy outcomes or ability to deliver adjuvant chemotherapy were observed between RARC and ORC. The increasing use of RARC is justifiable from an oncological viewpoint. PATIENT SUMMARY: In a retrospective study of patients who received perioperative chemotherapy for urothelial bladder cancer, we found no difference in key outcomes between robot-assisted radical cystectomy (RARC) and open radical cystectomy. Performing RARC seems to be justifiable in the multidisciplinary setting.
BACKGROUND: Little is known about the outcomes of robot-assisted radical cystectomy (RARC) compared to open radical cystectomy (ORC) combined with perioperative chemotherapy for muscle-invasive urothelial bladder cancer (UBC). OBJECTIVE: To evaluate surgical and oncological outcomes for RARC and ORC in multimodal treatment. DESIGN, SETTING, AND PARTICIPANTS: Data from 28 centres were collected for cystectomies performed between January 2000 and July 2013. INTERVENTION: RARC or ORC combined with perioperative chemotherapy for UBC. OUTCOME MEASURES AND STATISTICAL ANALYSIS: Fisher's exact tests, χ2 tests, and Wilcoxon rank-sum tests were used to compare the RARC and ORC groups. Logistic and Cox regression analyses were performed to evaluate potential prognostic factors. RESULTS AND LIMITATIONS: A total of 688 patients (n=603 ORC and n=85 RARC) were analysed; 60.6% received neoadjuvant chemotherapy, and 45.1% adjuvant chemotherapy. No significant differences in baseline characteristics were found between the groups. The median time from surgery to adjuvant chemotherapy was 1.9 mo for both RARC and ORC groups. The median number of lymph nodes removed was 21 (interquartile range [IQR] 14-35) for RARC and 13 (IQR 8-21) for ORC (p<0.001); the results were confirmed in subgroup analyses. Multivariable analyses revealed no difference in the rate of positive surgical margins (p=0.54 and p=0.78), rate of neobladder diversion (p=0.33 and p=0.51), relapse-free survival (p=0.31 and p=0.23), and overall survival (p=0.63 and p=0.69). The retrospective nature of the data is the major limitation. CONCLUSIONS: In this study, no differences in efficacy outcomes or ability to deliver adjuvant chemotherapy were observed between RARC and ORC. The increasing use of RARC is justifiable from an oncological viewpoint. PATIENT SUMMARY: In a retrospective study of patients who received perioperative chemotherapy for urothelial bladder cancer, we found no difference in key outcomes between robot-assisted radical cystectomy (RARC) and open radical cystectomy. Performing RARC seems to be justifiable in the multidisciplinary setting.
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