Early oncological outcomes for bladder urothelial carcinoma patients treated with robotic‐assisted radical cystectomy

Abstract

Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE To determine oncological outcomes including early survival rates among unselected bladder urothelial carcinoma (BUC) patients treated with robotic‐assisted radical cystectomy (RRC). PATIENTS AND METHODS Clinicopathologic and survival data were prospectively gathered for 85 consecutive BUC patients treated with RRC. The decision to undergo a robotic rather than open approach was made without regard to tumor volume or surgical candidacy. Kaplan–Meier survival rates were determined and stratified by tumor stage and LN positivity, and multivariate analysis was performed to identify independent predictors of survival. RESULTS Patients were relatively old (25% >80 years; median 73.5 years), with frequent comorbidities (46% with ASA class ≥3). Of these patients 28% had undergone previous pelvic radiation or pelvic surgery, and 20% had received neoadjuvant chemotherapy. Extended pelvic lymphadenectomy was performed in 98% of patients, with on average 19.1 LN retrieved. On final pathology, extravesical disease was common (36.5%). Positive surgicalmargins were detected in five (6%) patients, all of whom had extravesical tumors with perineural and/or lymphovascular invasion, and most of whom were >80 years old. At a mean postoperative interval of 18 months, 20 (24%) patients had developed recurrent disease, but only three (4%) patients had recurrence locally. Disease‐free, cancer‐specific and overall survival rates at 2 years were 74%, 85% and 79%, respectively. Patients with low‐stage/LN(−) cancers had significantly better survival than extravesical/LN(−) or any‐stage/LN(+) patients, with stage being the most important predictor on multivariate analysis. CONCLUSION RRC can achieve adequately high LN yields with a low positive margin rate among unselected BUC patients. Early survival outcomes are similar to those reported in contemporary open series, with an encouragingly low incidence of local recurrence, however long‐term follow‐up and head‐to‐head comparison with the open approach are still needed.

The Emergence of Surgeon-Controlled Robotic Surgery in Urologic Oncology

“…Kauffman and his team elaborated that these 2 year SCRRC survival data is almost identical to contemporary ORC series [29]. To note, however, surgical margins were positive in five patients [29]. Upon univariate analysis, though, margin positivety was significantly associated with extravesical primary tumor (P<0.01) and LN positivity (P=0.024) [29].…”

“…To note, however, surgical margins were positive in five patients [29]. Upon univariate analysis, though, margin positivety was significantly associated with extravesical primary tumor (P<0.01) and LN positivity (P=0.024) [29]. Kauffman et al explained that their positive margin rates met benchmark standards proposed by Herr et al at 6% overall (<10% recommended) and 14% with extravesical disease (<15% recommended) [29,30].…”

“…At an average postoperative follow up of 18 months, 20 (24%) patients had developed recurrent disease while disease-free survival, cancer-specific survival and overall survival rates at 2 years were 74%, 85% and 79%, respectively [29]. Kauffman and his team elaborated that these 2 year SCRRC survival data is almost identical to contemporary ORC series [29]. To note, however, surgical margins were positive in five patients [29].…”

“…In one of the most comprehensive RARC series to date, Kauffman et al followed 85 consecutive patients with bladder cancer treated with SCRRC between 2006 and 2008 [29]. At an average postoperative follow up of 18 months, 20 (24%) patients had developed recurrent disease while disease-free survival, cancer-specific survival and overall survival rates at 2 years were 74%, 85% and 79%, respectively [29].…”

Status of Robot-Assisted Radical Cystectomy (RARC) in 2012

“…Most groups lack long-term follow-up due to the novelty of RARC. Kauffman et al investigated outcomes in 85 RARC patients and reported 2 year recurrence free, cancer specific, and overall survival rates of 74%, 85%, and 79%, respectively [33]. Recent reports from the IRCC revealed overall survival rates of 82% and 71% at 1 and 2 years, respectively.…”