SUO 2017: Oncologic Outcomes Comparing Open and Robot-Assisted Laparoscopic Radical Cystectomy for Bladder Cancer

Washington, DC (UroToday.com) Dr. Marzouk and colleagues from Memorial Sloan Kettering Cancer Center reported oncological outcomes from their randomized control trial (RCT) comparing open (ORC) to robotic radical cystectomy (RARC). The authors previously reported the primary endpoints evaluating perioperative outcomes for ORC vs RARC1 demonstrating no advantage for robotic-assisted techniques over standard open surgery with regards to 90-day complication rates, length of hospital stay, and 3- and 6-month quality of life outcomes. The objective of this study was to report secondary endpoints of cancer specific outcomes from this prospective, randomized trial comparing RARC vs ORC. 

Between 2010 and 2013, 118 patients with clinical stage Ta-T3 bladder cancer were randomized to RARC (n=60) or ORC (n=58). Recurrent bladder cancer was defined according to the first site of disease detection. Disease location was defined as: (i) distant recurrence, (ii) local pelvic recurrence, (iii) abdominal recurrence (carcinomatosis or abdominal wall involvement), and (iv) secondary urothelial carcinoma. Kaplan-Meier methods were used to estimate recurrence and cancer-specific survival after radical cystectomy, and the log-rank test to compare differences in recurrence and cancer-specific survival rates. The median follow-up for these patients was 4.9 years (IQR 3.9, 5.9). There were 44 patients with recurrences: 25 after ORC, and 19 after RARC. There were 14 abdominal recurrences in five RARC patients, and four recurrences in two patients following ORC. Two of the five RARC patients with abdominal recurrences had organ-confined disease, including one with high-grade pTa disease. In the ORC group, two patients had non-organ confined disease and developed carcinomatosis but no abdominal wall involvement. In total, there were 36 deaths, including 19 deaths from bladder cancer. Overall recurrence rates (p=0.4) and bladder cancer specific death rates (p=0.4) were not statistically different between the groups. Risk of recurrence 2 years after surgery was 25% in the RARC arm and 28% in the ORC arm (difference -2.6%; 95%CI -19%, 14%) and 37% and 45% at 5 years (difference -8%; 95%CI -27%, 11%). The wide confidence intervals around the difference in recurrence risk precluded the authors from making conclusions regarding oncologic equivalence of the surgical modalities.

The authors concluded that a secondary analysis of cancer outcomes of this RCT revealed no significant difference in disease recurrence rates or cancer-specific survival between RARC and ORC. Observed patterns of recurrence based on surgical technique, were of interest, however the study was not powered to establish differences in patterns of recurrence.

References:
  1. Bochner BH, Dalbagni G, Sjoberg DD, et al. Comparing Open Radical Cystectomy and Robot-assisted Laparoscopic Radical Cystectomy: A Randomized Clinical Trial. Eur Urol 2015;67(6):1042-1050.
Presented by: Karim Marzouk, Memorial Sloan Kettering Cancer Center, Department of Surgery, Division of Urology, New York, NY
Co-Authors: Bernard Bochner, Guido Dalbagni, Daniel Sjoberg, Justin Lee, S. Machele Donat, Jonathan Coleman, Andrew Vickers, Raul Parra, Harry Herr, and Vincent Laudone

Written By: Zachary Klaassen, MD, Society of Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre @zklaassen_md at the 18th Annual Meeting of the Society of Urologic Oncology, November 20-December 1, 2017 – Washington, DC
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