CUA 2018: Patterns of Bladder Cancer Recurrence after Open and Robotic Radical Cystectomy

Halifax, Nova Scotia ( Pierre-Alain Hueber, MD, presented a study comparing open and robotic radical cystectomy in a single center. The rate /patterns of recurrence after robotic-assisted radical cystectomy (RARC) for bladder cancer may be different compared to open radical cystectomy (ORC). RARC has been thought lead to atypical recurrences, including peritoneal carcinomatosis, extra-pelvic lymph node metastasis and port side metastasis. 

This study aimed to compare rates and patterns of recurrence after RARC with intra-corporeal urinary diversion (IUCD) vs. ORC in a large contemporary cystectomy series. This was a retrospective study of 837 consecutive patients who underwent ORC (n=598) or RARC with ICUD (n=238) for bladder cancer between 2009 and 2016. The recurrences were either local, distant or secondary. Baseline characteristics of the patients are shown in table 1 and table 2.

Table 1- Patient clinical characteristics: 
Recurrence free survival Kaplan -Meier curves are demonstrated in Figure 1.

Figure 1 – Kaplan-Meier graphs for recurrence free survival:
Any kind of recurrence occurred in 13.4% of ORC and 14.8% of RARC with IUCD. Local recurrence occurred in 5.4% of ORC patients and 5.1% of RARC with IUCD patients. Multivariable cox regression analysis demonstrated that RARC with IUCD was not an independent predictor of recurrence after adjusting for age, sex, perioperative chemotherapy, pathological tumor and nodal status, lymphovascular invasion, and positive surgical margins.

Dr. Hueber concluded the interesting presentation by stating that there are no differences in the rates or patterns of local or distant recurrences between RARC and ICUD and ORC. The surgical approach is not an independent predictor of recurrence after radical cystectomy for bladder cancer.

Presented by: Pierre-Alain Hueber, MD, University of Southern California, Los Angeles, United States

Written ByHanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre, Twitter: @GoldbergHanan at the 73rd Canadian Urological Association Annual Meeting - June 23 - 26, 2018 - Halifax, Nova Scotia