Marco Moschini1, Francesco Soria2, Romain Mathieu3, Evanguelos Xylinas4, David D'Andrea5, Wei Shen Tan6, John D Kelly6, Giuseppe Simone7, Gabriele Tuderti7, Anoop Meraney8, Suprita Krishna9, Badrianath Konety9, Stefania Zamboni10, Philipp Baumeister10, Agostino Mattei10, Alberto Briganti11, Francesco Montorsi11, Michele Galucci7, Michael Rink12, Pierre I Karakiewicz13, Morgan Rouprêt14, Atiqullah Aziz14, Matt Perry15, Edward Rowe16, Anthony Koupparis16, Wassim Kassouf17, Douglas S Scherr18, Guillaume Ploussard19, Stephen A Boorjian20, Prasanna Sooriakumaran21, Shahrokh F Shariat22. 1. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy; Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland. Electronic address: marco.moschini@luks.ch. 2. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Division of Urology, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy. 3. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Department of Urology, Rennes University Hospital, Rennes, France. 4. Sorbonne Université, GRC no 5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, F-75013 Paris, France. 5. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria. 6. Division of Surgery and Intervention Science, University College London, London, United Kingdom; Department of Urology, University College London Hospital, London, United Kingdom; Department of Uro-oncology, University College London Hospital NHS Foundation Trust, London, United Kingdom. 7. "Regina Elena" National Cancer Institute, Department of Urology, Rome, Italy. 8. Urology Division, Hartford Healthcare Medical Group, Hartford, CT. 9. University of Minnesota, Department of Urology, Minneapolis, MN. 10. Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland. 11. Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy. 12. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 13. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada. 14. Department of Urology, University of Rostock, Rostock, Germany. 15. Department of Urology, St George's Hospital, London, United Kingdom. 16. Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom. 17. Department of Urology, McGill University Health Center, Montreal, Quebec, Canada. 18. Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY. 19. Department of Urology, Saint Jean Languedoc Hospital, Toulouse, France. 20. Department of Urology, Mayo Clinic, Rochester, MN. 21. Department of Uro-oncology, University College London Hospital NHS Foundation Trust, London, United Kingdom; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. 22. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: shahrokh.shariat@meduniwien.ac.at.
Abstract
INTRODUCTION: The use of robotic-assisted radical cystectomy (RARC) is becoming more widespread. While its safety is accepted, its oncological efficacy as compared to the current standard, open radical cystectomy (ORC), remains debatable. MATERIALS AND METHODS: The aim of this study is to compare the rates of positive soft tissue surgical margins (STSM), between patients treated with RARC or ORC, using a large contemporaneous collaborative database. We included 2,536 patients with urothelial carcinoma of the bladder treated at 26 institutions. A propensity-score matching 1:1 was performed with 3 ORC patients matched to 1 RARC patient. The final cohort included 1,614 patients. Uni- and multivariable logistic regression analyses tested the impact of surgical technique on STSM status, before and after propensity-score matching. RESULTS: Overall, 870 (34%) patients underwent RARC and 1,666 (66%) ORC. The overall STSM rate was 11%; 10% in the ORC group and 13% in the RARC group. Within the propensity-score-matched cohort, the positive STSM rate were 14% and 13% in the ORC and RARC group, respectively (P = 0.1). In multivariable analysis, after propensity match RARC approach was not associated with the risk of a positive STSM (P = 0.1). These results were confirmed in the subgroup of patients with pathologic non-organ-confined or organ-confined diseases. CONCLUSIONS: While treatment with RARC is associated with a higher absolute rate of STSM, the difference did not remain after adjustment for the effects of other established prognostic factors. Results from ongoing trials are awaited to assess the validity of these findings.
INTRODUCTION: The use of robotic-assisted radical cystectomy (RARC) is becoming more widespread. While its safety is accepted, its oncological efficacy as compared to the current standard, open radical cystectomy (ORC), remains debatable. MATERIALS AND METHODS: The aim of this study is to compare the rates of positive soft tissue surgical margins (STSM), between patients treated with RARC or ORC, using a large contemporaneous collaborative database. We included 2,536 patients with urothelial carcinoma of the bladder treated at 26 institutions. A propensity-score matching 1:1 was performed with 3 ORC patients matched to 1 RARC patient. The final cohort included 1,614 patients. Uni- and multivariable logistic regression analyses tested the impact of surgical technique on STSM status, before and after propensity-score matching. RESULTS: Overall, 870 (34%) patients underwent RARC and 1,666 (66%) ORC. The overall STSM rate was 11%; 10% in the ORC group and 13% in the RARC group. Within the propensity-score-matched cohort, the positive STSM rate were 14% and 13% in the ORC and RARC group, respectively (P = 0.1). In multivariable analysis, after propensity match RARC approach was not associated with the risk of a positive STSM (P = 0.1). These results were confirmed in the subgroup of patients with pathologic non-organ-confined or organ-confined diseases. CONCLUSIONS: While treatment with RARC is associated with a higher absolute rate of STSM, the difference did not remain after adjustment for the effects of other established prognostic factors. Results from ongoing trials are awaited to assess the validity of these findings.
Authors: Marco Moschini; Stefania Zamboni; Francesco Soria; Romain Mathieu; Evanguelos Xylinas; Wei Shen Tan; John D Kelly; Giuseppe Simone; Anoop Meraney; Suprita Krishna; Badrinath Konety; Agostino Mattei; Philipp Baumeister; Livio Mordasini; Francesco Montorsi; Alberto Briganti; Andrea Gallina; Armando Stabile; Rafael Sanchez-Salas; Xavier Cathelineau; Michael Rink; Andrea Necchi; Pierre I Karakiewicz; Morgan Rouprêt; Anthony Koupparis; Wassim Kassouf; Douglas S Scherr; Guillaume Ploussard; Stephen A Boorjian; Yair Lotan; Prasanna Sooriakumaran; Shahrokh F Shariat Journal: J Clin Med Date: 2019-08-09 Impact factor: 4.241
Authors: Frederik König; Benjamin Pradere; Nico C Grossmann; Fahad Quhal; Pawel Rajwa; Ekaterina Laukhtina; Keiichiro Mori; Satoshi Katayama; Takafumi Yanagisawa; Hadi Mostafai; Reza Sari Motlagh; Abdulmajeed Aydh; Roland Dahlem; Shahrokh F Shariat; Michael Rink Journal: Transl Cancer Res Date: 2022-04 Impact factor: 1.241