Comparison of 2-Year Oncological Outcome and Early Recurrence Patterns in Patients with Urothelial Bladder Carcinoma Treated with Open or Robot-Assisted Radical Cystectomy with an Extracorporeal Urinary Diversion

Abstract

Background: Data on oncological follow-up after robotic-assisted radical cystectomy (RARC) have been reported only scarcely and individual studies have reported an increase in early recurrences and atypical recurrences. Patients and Methods: Clinical data of 89 patients with RARC were compared to 59 patients with open radical cystectomy (ORC) at a single institution. Two-year cancer-specific (2y-CSS) and 2-year overall survival (2y-OS) related to histopathological tumor stage of RARC patients calculated by Kaplan-Meier method were compared to ORC patients using log-rank test. Early clinical recurrence rate (eCR, progression ≤6 months post-cystectomy) and metastatic pattern of both groups were compared by chi-square test. Results: Median follow-up 32 months (RARC) and 47.5 months (ORC), both groups were balanced in baseline characteristics. For RARC pts, ­2y-OS and CSS-free survival rates were 80 and 90%, for ORC pts 65 and 71% (all p > 0.05). Margin status was not significantly different. eCR was observed in 10 out of 89 (11%) RARC pts and in 7 out of 59 (12%) ORC pts (p = 0.9). No difference in atypical metastases was seen between groups. Conclusion: Two-year oncological outcomes of RARC patients are comparable to ORC patients without differences regarding ePR or metastatic pattern.

Review of the evidence for robotic-assisted robotic cystectomy and intra-corporeal urinary diversion in bladder cancer

“…This multi-institute phase-3 noninferiority trial found no inferiority of RARC compared to ORC in 2-year progression-free survival rates (RARC: 71.6% and ORC: 72.3%, P non-inferiority =0.001). Furthermore, similar 2-year survival outcomes were reported in several retrospective analyses (9,10). Admittedly, the 2-year followup period appears short in the RAZOR trial, however several studies reveal that 2-year follow-up is adequate to identify up to 81% of recurrences (11,12).…”

Does robotic radical cystectomy impede oncological outcome in bladder cancer patients?

“…For example, in the RAZOR (RARC versus ORC in patients with bladder cancer) trial, no differences in 2-year progression-free survival rate comparing ORC and RARC patients (RARC 72.3%, ORC 71.6%) was observed indicating non-inferiority of the robotic approach. In addition, a number of retrospective analysis support these findings as well (13-15). In fact, these results are not unexpected, as RARC has already been shown to be safe regarding perioperative predictors of oncological outcomes as lymph node yield and margin status.…”

Incidence, Timing, and Pattern of Atypical Recurrence after Minimally Invasive Surgery for Urothelial Carcinoma

“…In several articles, it was noted that ARs were not the only recurrence presentation. Indeed, in most cases, ARs were associated with distant metastases [ 17 , 18 ]. However, determining the true incidence of ARs is a challenging task for different reasons.…”