Propensity-score-matched comparison of soft tissue surgical margins status between open and robotic-assisted radical cystectomy

The use of robotic-assisted radical cystectomy (RARC) is becoming more widespread. While its safety is accepted, its oncological efficacy as compared to the current standard, open radical cystectomy (ORC), remains debatable.

The aim of this study is to compare the rates of positive soft tissue surgical margins (STSM), between patients treated with RARC or ORC, using a large contemporaneous collaborative database. We included 2,536 patients with urothelial carcinoma of the bladder treated at 26 institutions. A propensity-score matching 1:1 was performed with 3 ORC patients matched to 1 RARC patient. The final cohort included 1,614 patients. Uni- and multivariable logistic regression analyses tested the impact of surgical technique on STSM status, before and after propensity-score matching.

Overall, 870 (34%) patients underwent RARC and 1,666 (66%) ORC. The overall STSM rate was 11%; 10% in the ORC group and 13% in the RARC group. Within the propensity-score-matched cohort, the positive STSM rate were 14% and 13% in the ORC and RARC group, respectively (P = 0.1). In multivariable analysis, after propensity match RARC approach was not associated with the risk of a positive STSM (P = 0.1). These results were confirmed in the subgroup of patients with pathologic non-organ-confined or organ-confined diseases.

While treatment with RARC is associated with a higher absolute rate of STSM, the difference did not remain after adjustment for the effects of other established prognostic factors. Results from ongoing trials are awaited to assess the validity of these findings.

Urologic oncology. 2018 Nov 13 [Epub ahead of print]

Marco Moschini, Francesco Soria, Romain Mathieu, Evanguelos Xylinas, David D'Andrea, Wei Shen Tan, John D Kelly, Giuseppe Simone, Gabriele Tuderti, Anoop Meraney, Suprita Krishna, Badrianath Konety, Stefania Zamboni, Philipp Baumeister, Agostino Mattei, Alberto Briganti, Francesco Montorsi, Michele Galucci, Michael Rink, Pierre I Karakiewicz, Morgan Rouprêt, Atiqullah Aziz, Matt Perry, Edward Rowe, Anthony Koupparis, Wassim Kassouf, Douglas S Scherr, Guillaume Ploussard, Stephen A Boorjian, Prasanna Sooriakumaran, Shahrokh F Shariat, European Association of Urology – Young Academic Urologists (EAU-YAU), Urothelial Carcinoma Working Group

Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy; Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland. Electronic address: ., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Division of Urology, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Department of Urology, Rennes University Hospital, Rennes, France., Sorbonne Université, GRC no 5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, F-75013 Paris, France., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria., Division of Surgery and Intervention Science, University College London, London, United Kingdom; Department of Urology, University College London Hospital, London, United Kingdom; Department of Uro-oncology, University College London Hospital NHS Foundation Trust, London, United Kingdom., "Regina Elena" National Cancer Institute, Department of Urology, Rome, Italy., Urology Division, Hartford Healthcare Medical Group, Hartford, CT., University of Minnesota, Department of Urology, Minneapolis, MN., Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland., Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy., Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, Quebec, Canada., Department of Urology, University of Rostock, Rostock, Germany., Department of Urology, St George's Hospital, London, United Kingdom., Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, United Kingdom., Department of Urology, McGill University Health Center, Montreal, Quebec, Canada., Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY., Department of Urology, Saint Jean Languedoc Hospital, Toulouse, France., Department of Urology, Mayo Clinic, Rochester, MN., Department of Uro-oncology, University College London Hospital NHS Foundation Trust, London, United Kingdom; Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX. Electronic address: .