Early Oncologic Failure after Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium

Abstract

Background: There have been concerns regarding incidences of peritoneal recurrences and

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

“…Although the number of patients experiencing eCR in our series is lower compared to what has been previously published [13,18], we could not find any rate difference after stratification for the technique used. Therefore, we checked if any different pattern of metastasis between ORC and RARC groups occurred.…”

“…In this context, we already reported a positive margin rate of 6.4% and a median lymph-node yield of 20 (IQR 13-23) nodes in our prior publication on perioperative outcomes in 2014, which fulfills the surgical standards as proposed by Herr et al [19] and was comparable to our ORC cohort [3]. Both positive margin rate (8%) and lymph-node yield (17)(18)(19)(20)(21)(22)(23)(24)) remained stable over the time.…”

“…Therefore, we checked if any different pattern of metastasis between ORC and RARC groups occurred. No port-site recurrence was recorded, although described in the literature [12,13,18]. Atypical recurrence was observed in 4/10 RARC patients (1 peritoneal carcinomatosis and 3 retroperitoneal lymph nodes) and 3/7 ORC patients (1 peritoneal carcinomatosis and 2 retroperitoneal lymph nodes).…”

“…Among those studies, the recent observation of unusual metastatic dissemination after RARC, although not statistically significant in comparison to ORC, has raised many criticisms on the robotic technique [13]. Thereafter, several papers (all retrospective, one multi-institutional and one comparative), concluded, although not in a universal fashion, that atypical dissemination after RARC owed to disease biological (pT3/pT4 disease, positive nodal status, lymphovascular invasion, presence of Cis) or perioperative features (eGFR < 60 mL/min/1.73 m 2 , blood transfusion, perioperative chemotherapy), rather than to the technique used [12,13,18]. Other studies advocated a role of the intermittent gas insufflation and squeezing of cancer cells in the Batson's plexus has been hypothesized and requires further investigation [12,15].…”

Is the open cystectomy era over? An update on the available evidence

“…We have to keep in mind though that the aforementioned study received criticism for statistical flaws, which might have led to a false conclusion . In addition, both the IRCC and the European Association of Urology Robotic Urology Section Group have reported that peritoneal carcinomatosis is very rare during RARC (1% and 0.7%, respectively), similarly to open surgery . Thus, the issue of potential peritoneal tumor spread as a result of the effect of pneumoperitoneum warrants further research.…”