NARUS 2018: Bladder Cancer Recurrence After Robotic and Open Radical Cystectomy: A Contemporary Single Center Experience
The authors reviewed a prospectively maintained institutional bladder cancer database to identify 837 consecutive patients. Recurrences were classified as local, distant or secondary urothelial carcinomas, and one and two-year recurrence patterns were assessed. The Kaplan-Meier method was used for RFS estimates.
There were 238 patients (28.4%) that underwent RARC and 598 patients (71.6%) that underwent ORC; all patients undergoing RARC had intracorporeal urinary diversion. There were no differences in baseline patient characteristics between the two groups with respect to age, race, smoking history, BMI, Charlson Comorbidity Score (CCS), ASA score, previous abdominal surgery, and previous radiotherapy. Additionally, treatment characteristics were similar between the groups considering number of TURBTs prior to cystectomy, receipt of neoadjuvant chemotherapy, and receipt of chemotherapy. Interestingly, patients undergoing RARC were more likely to have an ileal conduit urinary diversion (64% vs 29%, p<0.001). On cystectomy, RARC patients had more pT3 disease (30.4% vs 20.2%, p=0.002) and extravesical disease (38.0% vs 30.1%, p=0.03) compared to ORC. There were no differences between the cohorts for multifocality, presence of CIS, lymphovascular invasion, positive margins, or pN+ disease. Importantly, the 1-year recurrence patterns between the two groups were similar: any recurrence (RARC 14.8% vs ORC 13.4%), local recurrence (5.1% vs 5.4%), and distant recurrence (12.7% vs 11.0%). Furthermore, there were no differences with respect to peritoneal carcinomatosis (1.3% vs 1.2%) and extra-pelvic lymph node metastasis (1.3% vs 1.8%). Regarding survival, there was no difference in RFS for the overall cohort (p=0.39), as well as for organ-confined disease (p=0.27), extravesical disease (p=0.55) or node-positive disease (p=0.68). The authors acknowledge the limitation of the retrospective nature of the study, however note that this is the largest series comparing recurrence patterns following RARC and ORC.
The authors concluded that in their large contemporary series, there were no differences in the rates or patterns of recurrence between RARC with intracorporeal urinary diversion and ORC. Importantly, based on this data, the authors surmise that the robotic surgical approach is not a predictor of recurrence after radical cystectomy for bladder cancer.
Presented By: Akbar N. Ashrafi, University of Southern California, Los Angeles, CA
Co-Authors: Nieroshan Rajaruberndra, Pierre-Alain Hueber, Giovanni E. Cacciamani, Luis G. Medina, Matthew Winter, Andre L. de Castro Abreu, Siamak Daneshmand, Monish Aron, Inderbir S. Gill, Andre K. Berger, Mihir M. Desai
Written By: Zachary Klaassen, MD, Urologic Oncology Fellow, University of Toronto, Princess Margaret Cancer Centre, @zklaassen_md ,at the 2018 North American Robotic Urology Symposium, February 16-17, 2018 - Las Vegas, NV
References:
1. Nguyen DP, Al Hussein Al Awamlh B, Wu X, et al. Recurrence patterns after open and robot-assisted radical cystectomy for bladder cancer. Eur Urol 2015;68(3):399-405.