Ten-Year Oncologic Outcomes Following Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium.

Radical cystectomy (RC) is the gold standard for non-metastatic muscle invasive bladder cancer, and for refractory non-muscle invasive disease. Compared to open RC, robot-assisted radical cystectomy (RARC) has been shown to provide comparable early oncologic outcomes and improved perioperative outcomes. However, there is paucity of data about long term oncologic outcomes, and concerns about higher incidence of local recurrence after RARC. We sought to report the 10-year oncologic outcomes following RARC utilizing a multinational database.

A retrospective review of the prospective International Robotic Cystectomy Consortium (IRCC) database was performed. Consecutive patients who underwent RARC 10 years ago or earlier were included. Data were reviewed for demographics, perioperative, pathologic and oncologic outcomes. Kaplan Meier curves were used to depict recurrence-free (RFS), disease-specific (DSS), and overall survival (OS). Multivariate stepwise Cox regressions models were used to identify variables associated with RFS, DSS and OS.

446 patients were identified with median age of 67 (IQR 59-76 years). Ten percent received neoadjuvant chemotherapy, 51% experienced any complication, 23% had high grade complications and 4% died within 3 months of RARC. Forty three percent had ≥pT3, 24% had pN+ disease, and positive soft tissue surgical margin was observed in 7%. After median follow up of 5 years (IQR 2-10, maximum follow up 14 years), 15% and 29% developed local and distant recurrences, respectively. The 10-year RFS, DSS and OS were 59%, 65% and 35% respectively. Patients with ≥pT3 and pN+ exhibited worse RFS, DSS and OS.

Long term oncologic outcomes, recurrence rates and recurrence patterns after RARC seem comparable to open series. Advanced disease stage and positive surgical margins remain the main determinants of survival after RC.

The Journal of urology. 2019 Jun 12 [Epub ahead of print]

Ahmed A Hussein, Ahmed S Elsayed, Naif A Aldhaam, Zhe Jing, Jennifer Osei, Jihad Kaouk, Juan Palou Redorta, Mani Menon, James Peabody, Prokar Dasgupta, Mohammed Shamim Khan, Alexandre Mottrie, Michael Stöckle, Ashok Hemal, Lee Richstone, Abolfazl Hosseini, Peter Wiklund, Francis Schanne, Eric Kim, Koon Ho Rha, Khurshid A Guru

Roswell Park Comprehensive Cancer Center , NY , USA., Glickman Urological and Kidney Institute, Cleveland Clinic , OH , USA., FundacióPuigvert , Barcelona , Spain., Henry Ford Health System , MI , USA., Guy's Hospital and King's College London School of Medicine , London , UK., Onze-Lieve-Vrouw Ziekenhuis , Aalast , Belgium., University of the Saarland , Homburg Saar , Germany., Wake Forest University Baptist Medical Center , Winston-Salem , NC , USA., Arthur Smith Institute for Urology , NY , USA., Karolinska Institute , Stockholm , Sweden., Urological Surgical Associates of Delaware , Wilmington , DE., Washington University School of Medicine , St. Louis , MO., Yonsei Medical Health System , Seoul , South Korea.