Stefania Zamboni1,2, Francesco Soria3,4, Romain Mathieu3,5, Evanguelos Xylinas6, Mohammad Abufaraj3,7, David D Andrea3, Wei Shen Tan8,9,10, John D Kelly8,9,10, Giuseppe Simone11, Michele Gallucci11, Anoop Meraney12, Suprita Krishna13, Badrinath R Konety13, Alessandro Antonelli2, Claudio Simeone2, Philipp Baumeister1, Agostino Mattei1, Alberto Briganti14, Andrea Gallina14, Francesco Montorsi14, Michael Rink15, Atiqullah Aziz16, Pierre I Karakiewicz17, Morgan Rouprêt18, Anthony Koupparis19, Douglas S Scherr20, Guillaume Ploussard21, Prasanna Sooriakumaran10,22, Shahrokh F Shariat3,20,23, Marco Moschini1,3. 1. Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland. 2. Urology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili, University of Brescia, Vienna, Austria. 3. Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria. 4. Division of Urology, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy. 5. Department of Urology, Rennes University Hospital, Rennes, France. 6. Department of Urology Bichat Hospital, Paris Descartes University, Paris, France. 7. Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan. 8. Division of Surgery and Intervention Science, University College London, London, UK. 9. Department of Urology, University College London Hospital, London, UK. 10. Department of Uro-oncology, University College London Hospital NHS Foundation Trust, London, UK. 11. Department of Urology, "ReginaElena" National Cancer Institute, Rome, Italy. 12. Urology Division, Hartford Healthcare Medical Group, Hartford, CT, USA. 13. Department of Urology, University of Minnesota, Minneapolis, MN, USA. 14. Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy. 15. Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 16. Department of Urology, University Medical Center Rostock, Rostock, Germany. 17. Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada. 18. GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France. 19. Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, UK. 20. Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA. 21. Department of Urology, La croix du sud, Toulouse, France. 22. Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden. 23. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Abstract
OBJECTIVES: To compare trends in the use of robot-assisted radical cystectomy (RARC) and changes over time in peri-operative outcomes in selected North American and European centres. MATERIALS AND METHODS: We conducted a retrospective evaluation of 2401 patients treated with open radical cystectomy (ORC) or RARC for bladder cancer at 12 centres in North America and Europe between 2006 and 2018. We used the Kruskal-Wallis and chi-squared test to evaluate differences between continuous and categorical variables. RESULTS: Overall, 49.5% of patients underwent RARC and 51.5% ORC. RARC became the most commonly performed procedure in contemporary patients, with an increase from 29% in 2006-2008 to 54% in 2015-2018 (P < 0.001). In the North American centres the use of RARC was higher than that of ORC from 2006, and remained stable over time, whereas in the European centres its use increased exponentially from 2% to 50%. In both groups patients who underwent RARC had less advanced T stages (P < 0.001), lower American Society of Anesthesiologists scores (P < 0.05), lower blood loss (P = 0.001) and shorter length of hospital stay (P < 0.05). No differences were found in early complications. Early readmission and re-operation rates were worse for patients treated with RARC in the European centres; however, when contemporary patients only were considered, the statistical significance was lost. CONCLUSION: The present study shows that the use of RARC has constantly increased since its introduction, overtaking ORC in the most contemporary series. While RARC was more frequently performed than ORC since its introduction in the North American centres and its use remained substantially stable over time, its use increased exponentially in the European centres. The different trends in use of RARC/ORC and changes over time in peri-operative outcomes between the North American and European centres can be attributed to the earlier introduction and spread of RARC in the former compared with the latter.
OBJECTIVES: To compare trends in the use of robot-assisted radical cystectomy (RARC) and changes over time in peri-operative outcomes in selected North American and European centres. MATERIALS AND METHODS: We conducted a retrospective evaluation of 2401 patients treated with open radical cystectomy (ORC) or RARC for bladder cancer at 12 centres in North America and Europe between 2006 and 2018. We used the Kruskal-Wallis and chi-squared test to evaluate differences between continuous and categorical variables. RESULTS: Overall, 49.5% of patients underwent RARC and 51.5% ORC. RARC became the most commonly performed procedure in contemporary patients, with an increase from 29% in 2006-2008 to 54% in 2015-2018 (P < 0.001). In the North American centres the use of RARC was higher than that of ORC from 2006, and remained stable over time, whereas in the European centres its use increased exponentially from 2% to 50%. In both groups patients who underwent RARC had less advanced T stages (P < 0.001), lower American Society of Anesthesiologists scores (P < 0.05), lower blood loss (P = 0.001) and shorter length of hospital stay (P < 0.05). No differences were found in early complications. Early readmission and re-operation rates were worse for patients treated with RARC in the European centres; however, when contemporary patients only were considered, the statistical significance was lost. CONCLUSION: The present study shows that the use of RARC has constantly increased since its introduction, overtaking ORC in the most contemporary series. While RARC was more frequently performed than ORC since its introduction in the North American centres and its use remained substantially stable over time, its use increased exponentially in the European centres. The different trends in use of RARC/ORC and changes over time in peri-operative outcomes between the North American and European centres can be attributed to the earlier introduction and spread of RARC in the former compared with the latter.
Authors: Paolo Dell'Oglio; Filippo Turri; Alessandro Larcher; Frederiek D'Hondt; Rafael Sanchez-Salas; Bernard Bochner; Joan Palou; Robin Weston; Abolfazl Hosseini; Abdullah E Canda; Jørgen Bjerggaard; Giovanni Cacciamani; Kasper Ørding Olsen; Inderbir Gill; Thierry Piechaud; Walter Artibani; Pim J van Leeuwen; Arnulf Stenzl; John Kelly; Prokar Dasgupta; Carl Wijburg; Justin W Collins; Mihir Desai; Henk G van der Poel; Francesco Montorsi; Peter Wiklund; Alexandre Mottrie Journal: Eur Urol Focus Date: 2021-01-02