Comparison of Oncologic Outcomes Following Open and Robotic-assisted Radical Cystectomy with both Extracorporeal and Intracorporeal Urinary Diversion.

To compare oncologic endpoints between open radical cystectomy (ORC) and robotic-assisted radical cystectomy with extracorporeal urinary diversion (eRARC) or intracorporeal urinary diversion (iRARC).

Retrospective review of all patients undergoing curative-intent radical cystectomy with urinary diversion for urothelial bladder cancer at a single-institution from 2010-2018. Primary outcomes included recurrence location and rates, recurrence-free (RFS) and overall survival (OS). Survival estimates were obtained using the Kaplan-Meier method and compared using log-rank analysis. Cox proportional-hazards model was used to identify predictors of survival.

265, 366 and 285 patients underwent ORC, eRARC, and iRARC, respectively (n=916). Median follow-up was 52, 40 and 37 months for ORC, eRARC and iRARC, respectively (p<0.001). Ileal conduit was more commonly performed in iRARC (85%, p<0.001). Neobladder rates did not vary. Neoadjuvant (p=0.4) or adjuvant therapy use (p=0.36), pT-stage (p=0.28) or pN-stage (p=0.1) did not differ. Positive soft tissue margin rates were higher in ORC (7.2%-ORC, 3.6%-eRARC, 3.2%-iRARC, p=0.041). Differences in recurrence rates or location were not observed. Surgical approach was not associated with any survival endpoint on proportional-hazards or Kaplan-Meier analysis. Hazard ratios and 95% CI for RFS were 1 (0.72-14) and 0.93 (0.66-1.3) for eRARC and iRARC, respectively, when compared to ORC as the referent.

These findings from a large, single-institution in conjunction with randomized-controlled trial data suggest that RARC does not compromise perioperative or long-term oncologic outcomes when compared to ORC.

Urology. 2021 Apr 20 [Epub ahead of print]

Prithvi B Murthy, Zaeem Lone, Carlos Munoz-Lopez, J J Zhang, Kyle Ericson, Lewis Thomas, Maxx Caveney, Daniel Gerber, Abhinav Khanna, Robert Abouassaly, Georges-Pascal Haber, Byron H Lee

Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA. Electronic address: ., Department of Urology, Glickman Urological & Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA.

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