OBJECTIVES: To characterize the surgical feasibility and outcomes of robot-assisted radical cystectomy (RARC) for pathologic T4 bladder cancer.
SUBJECTS/PATIENTS: Retrospective evaluation of a prospectively maintained IRCC database was conducted for 1118 patients who underwent RARC between 2003 and 2012. We dichotomized patients based on pathologic stage (≤pT3 versus pT4) and evaluated demographic, operative and pathologic variables in relation to morbidity and mortality.
RESULTS: Total of 1000 ≤pT3 and 118 pT4 patients were evaluated. pT4 patients were on average older than ≤pT3 patients ( p=0.001). Median operative time and blood loss were 386 min, and 350 cc vs. 396 min and 350 cc for p T4 and ≤ p T3, respectively. Complication rate was similar (54% vs. 58%; P = 0.64) among ≤pT3 and pT4 patients, respectively. The overall 30 and 90-day mortality rate was 0.4% and 1.8% versus 4.2% and 8.5% for ≤pT3 versus pT4 patients (P = <0.001), respectively. Body mass index (BMI), American Society of Anesthesiology score (ASA), length of hospital stay (LOS) >10 days, and 90-day readmission were significantly associated with complications in pT4 patients. Meanwhile, BMI, LOS >10 days, grade 3-5 complications, 90-day readmission, smoking, previous abdominal surgery and neoadjuvant chemotherapy were significantly associated with mortality in pT4 patients. On multivariate analysis, BMI was an independent predictor of complications in pT4 patients, but not for mortality.
CONCLUSIONS: RARC for pT4 bladder cancer is surgically feasible but entails significant morbidity and mortality. BMI was independent predictor of complications in pT4 patients.
Al-Daghmin A, Kauffman EC, Shi Y, Badani K, Balbay MD, Canda E, Dasgupta P, Ghavamian R, Grubb R 3rd, Hemal A, Kaouk J, Kibel AS, Maatman T, Menon M, Mottrie A, Nepple K, Pattaras JG, Peabody JO, Poulakis V, Pruthi R, Redorta JP, Rha KH, Richstone L, Schanne F, Scherr DS, Siemer S, Stöckle M, Wallen EM, Weizer A, Wiklund P, Wilson T, Wilding G, Woods M, Guru KA Are you the author?
Roswell Park Cancer Institute, Buffalo, NY
Reference: BJU Int. 2013 Nov 13 (Epub ahead of print)