Robot-assisted Versus Open Radical Cystectomy in Patients Receiving Perioperative Chemotherapy for Muscle-invasive Bladder Cancer: The Oncologist's Perspective from a Multicentre Study

Little is known about the outcomes of robot-assisted radical cystectomy (RARC) compared to open radical cystectomy (ORC) combined with perioperative chemotherapy for muscle-invasive urothelial bladder cancer (UBC).

To evaluate surgical and oncological outcomes for RARC and ORC in multimodal treatment.

Data from 28 centres were collected for cystectomies performed between January 2000 and July 2013.

RARC or ORC combined with perioperative chemotherapy for UBC.

Fisher's exact tests, χ(2) tests, and Wilcoxon rank-sum tests were used to compare the RARC and ORC groups. Logistic and Cox regression analyses were performed to evaluate potential prognostic factors.

A total of 688 patients (n=603 ORC and n=85 RARC) were analysed; 60.6% received neoadjuvant chemotherapy, and 45.1% adjuvant chemotherapy. No significant differences in baseline characteristics were found between the groups. The median time from surgery to adjuvant chemotherapy was 1.9 mo for both RARC and ORC groups. The median number of lymph nodes removed was 21 (interquartile range [IQR] 14-35) for RARC and 13 (IQR 8-21) for ORC (p<0.001); the results were confirmed in subgroup analyses. Multivariable analyses revealed no difference in the rate of positive surgical margins (p=0.54 and p=0.78), rate of neobladder diversion (p=0.33 and p=0.51), relapse-free survival (p=0.31 and p=0.23), and overall survival (p=0.63 and p=0.69). The retrospective nature of the data is the major limitation.

In this study, no differences in efficacy outcomes or ability to deliver adjuvant chemotherapy were observed between RARC and ORC. The increasing use of RARC is justifiable from an oncological viewpoint.

In a retrospective study of patients who received perioperative chemotherapy for urothelial bladder cancer, we found no difference in key outcomes between robot-assisted radical cystectomy (RARC) and open radical cystectomy. Performing RARC seems to be justifiable in the multidisciplinary setting.

European urology focus. 2017 Mar 31 [Epub ahead of print]

Andrea Necchi, Gregory R Pond, Marc C Smaldone, Sumanta K Pal, Kevin Chan, Yu-Ning Wong, Rosalia Viterbo, Guru Sonpavde, Lauren C Harshman, Simon Crabb, Ajjai Alva, Simon Chowdhury, Ugo De Giorgi, Sandy Srinivas, Neeraj Agarwal, Aristotelis Bamias, Jack Baniel, Ali-Reza Golshayan, Sylvain Ladoire, Cora N Sternberg, Linda Cerbone, Evan Y Yu, Joaquim Bellmunt, Ulka Vaishampayan, Gunter Niegisch, Syed Hussain, Daniel W Bowles, Rafael Morales-Barrera, Matthew I Milowsky, Christine Theodore, Dominik R Berthold, Srikala S Sridhar, Thomas Powles, Jonathan E Rosenberg, Matthew D Galsky, Retrospective International Study of Invasive/Advanced Cancer of the Urothelium (RISC)

Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: ., McMaster University, Hamilton, Ontario, Canada., Fox Chase Cancer Center, Philadelphia, PA, USA., City of Hope Comprehensive Cancer Center, Duarte, CA, USA., UAB Comprehensive Cancer Center, Birmingham, AL, USA., Dana Farber Cancer Institute, Boston, MA, USA., University of Southampton, Southampton, UK., University of Michigan, Ann Arbor, MI, USA., Guy's and St. Thomas' Hospital, London, UK., IRCCS Istituto Scientifico Romagnolo per lo studio e la Cura dei Tumori, Meldola, Italy., Stanford University School of Medicine, Stanford, CA, USA., University of Utah, Salt Lake City, UT, USA., University of Athens, Athens, Greece., Rabin Medical Center, Petach Tikva, Israel., Medical University of South Carolina, Charleston, SC, USA., Centre Georges-François Leclerc, Dijon, France., San Camillo Forlanini Hospital, Rome, Italy., University of Washington, Seattle, WA, USA., Karmanos Cancer Institute, Detroit, MI, USA., Heinrich-Heine-University, Düsseldorf, Germany., University of Liverpool, Liverpool, UK., Denver Veterans Affairs Medical Center, Eastern Colorado Health Care System, Denver, CO, USA., Vall d'Hebron Institute of Oncology, Vall d'Hebron University Hospital, Universitat Autonoma de Barcelona, Barcelona, Spain., University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, NC, USA., Hopital Foch, Suresnes, France., Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland., Princess Margaret Hospital, University Health Network, Toronto, Canada., Barts Health and the Royal Free NHS Trust, Queen Mary University of London, London, UK., Memorial Sloan-Kettering Cancer Center, New York, NY, USA., Mount Sinai School of Medicine, Tisch Cancer Institute, New York, NY, USA.