Jong Jin Oh1,2, Sangchul Lee1, Ja Hyeon Ku2,3, Tae Gyun Kwon4, Tae-Hwan Kim4, Seung Hyun Jeon5, Sang Hyup Lee5, Jong Kil Nam6, Wan Seok Kim7, Byong Chang Jeong8, Ji Youl Lee9, Sung Hoo Hong9, Koon Ho Rha10, Woong Kyu Han10, Won Sik Ham10, Young Goo Lee11, Yong Seong Lee12, Sung Yul Park13, Young Eun Yoon13, Sung Gu Kang14, Seok Ho Kang14. 1. Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea. 2. Department of Urology, Seoul National University College of Medicine, Seoul, Korea. 3. Department of Urology, Seoul National University Hospital, Seoul, Korea. 4. Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea. 5. Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea. 6. Department of Urology, Busan National University Yangsan Hospital, Yangsan, Korea. 7. Department of Urology, College of Medicine, Busan Paik Hospital, Inje University, Busan, Korea. 8. Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 9. Department of Urology, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea. 10. Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. 11. Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea. 12. Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea. 13. Department of Urology, Hanyang University College of Medicine, Seoul, Korea. 14. Department of Urology, Korea University College of Medicine, Seoul, Korea.
Abstract
OBJECTIVES: To investigate the oncological significance of a robot-assisted radical cystectomy (RARC)-related pentafecta in patients with bladder cancer. PATIENTS AND METHODS: Using the KORARC database, which includes data from 12 centres, data from 730 patients who underwent RARC between April 2007 and May 2019 were prospectively collected and retrospectively analysed. Pentafecta was achieved if patients met all of the following criteria: (i) negative soft tissue surgical margin; (ii) ≥16 lymph nodes removed; (iii) no major complications (Clavien-Dindo grade 3-5) within 90 days; (iv) no clinical recurrence within the first 12 months; and (v) no ureteroenteric stricture. Patients were divided into two groups according to pentafecta attainment, and a comparison of overall survival (OS) and cancer-specific survival (CSS) using multivariate Cox proportional analysis was then carried out. RESULTS: Of the 730 patients included in this analysis, 208 (28.5%) attained the RARC pentafecta; the remaining 522 (71.5%) did not. The mean age of the patients was 64.67 years, 85.1% were men, 53.6% received a conduit, 37.7% received orthotopic neobladders and the total complication rate was 57.8%. Those who attained the pentafecta received more neobladders (P = 0.039), were more likely to be treated with the intracorporeal technique (P < 0.001), had longer operating times (P = 0.020) and had longer console time (P = 0.021) compared with those who did not attain the pentafecta. Over a mean of 31.1 months of follow-up, the pentafecta attainment group had significantly higher OS and CSS rates compared with the non-attainment group (10-year OS 70.4% vs 58.1%, respectively [P = 0.016]; 10-year CSS 87.8% vs 70.0%, respectively [P = 0.036]). Multivariate analysis showed that the RARC pentafecta was a significant predictor of overall mortality (hazard ratio 0.561; P = 0.038). CONCLUSIONS: Patients who attained the RARC pentafecta had significantly better survival outcomes compared with those who did not. These criteria could be used to standardize assessment of the surgical quality of RARC. In the future, a similar study using an independent cohort is warranted to confirm our results.
OBJECTIVES: To investigate the oncological significance of a robot-assisted radical cystectomy (RARC)-related pentafecta in patients with bladder cancer. PATIENTS AND METHODS: Using the KORARC database, which includes data from 12 centres, data from 730 patients who underwent RARC between April 2007 and May 2019 were prospectively collected and retrospectively analysed. Pentafecta was achieved if patients met all of the following criteria: (i) negative soft tissue surgical margin; (ii) ≥16 lymph nodes removed; (iii) no major complications (Clavien-Dindo grade 3-5) within 90 days; (iv) no clinical recurrence within the first 12 months; and (v) no ureteroenteric stricture. Patients were divided into two groups according to pentafecta attainment, and a comparison of overall survival (OS) and cancer-specific survival (CSS) using multivariate Cox proportional analysis was then carried out. RESULTS: Of the 730 patients included in this analysis, 208 (28.5%) attained the RARC pentafecta; the remaining 522 (71.5%) did not. The mean age of the patients was 64.67 years, 85.1% were men, 53.6% received a conduit, 37.7% received orthotopic neobladders and the total complication rate was 57.8%. Those who attained the pentafecta received more neobladders (P = 0.039), were more likely to be treated with the intracorporeal technique (P < 0.001), had longer operating times (P = 0.020) and had longer console time (P = 0.021) compared with those who did not attain the pentafecta. Over a mean of 31.1 months of follow-up, the pentafecta attainment group had significantly higher OS and CSS rates compared with the non-attainment group (10-year OS 70.4% vs 58.1%, respectively [P = 0.016]; 10-year CSS 87.8% vs 70.0%, respectively [P = 0.036]). Multivariate analysis showed that the RARC pentafecta was a significant predictor of overall mortality (hazard ratio 0.561; P = 0.038). CONCLUSIONS:Patients who attained the RARC pentafecta had significantly better survival outcomes compared with those who did not. These criteria could be used to standardize assessment of the surgical quality of RARC. In the future, a similar study using an independent cohort is warranted to confirm our results.
Authors: Łukasz Zapała; Aleksander Ślusarczyk; Bartłomiej Korczak; Paweł Kurzyna; Mikołaj Leki; Piotr Lipiński; Jerzy Miłow; Michał Niemczyk; Kamil Pocheć; Michał Późniak; Maciej Przudzik; Tomasz Suchojad; Rafał Wolański; Piotr Zapała; Tomasz Drewa; Marek Roslan; Waldemar Różański; Andrzej Wróbel; Piotr Radziszewski Journal: Front Oncol Date: 2022-01-26 Impact factor: 6.244
Authors: P Baron; Z Khene; F Lannes; G Pignot; A S Bajeot; G Ploussard; G Verhoest; A Gasmi; O Perrot; M Roumiguie; K Mori; G E Cacciamani; M Rouprêt; F Bruyère; B Pradere Journal: World J Urol Date: 2021-07-03 Impact factor: 4.226