Predictors of Recurrence, and Progression-Free and Overall Survival following Open versus Robotic Radical Cystectomy: Analysis from the RAZOR Trial with a 3-Year Followup

Venkatramani, Vivek; Reis, Isildinha M.; Castle, Erik P.; Gonzalgo, Mark L.; Woods, Michael; Svatek, Robert S.; Weizer, Alon Z.; Konety, Badrinath R.; Tollefson, Mathew; Krupski, Tracey L.; Smith, Norm D.; Shabsigh, Ahmad; Barocas, Daniel A.; Quek, Marcus L.; Dash, Atreya; Kibel, Adam S.; Pruthi, Raj S.; Montgomery, Jeffrey S.; Weight, Christopher J.; Sharp, David; Chang, Sam S.; Cookson, Michael S.; Gupta, Gopal N.; Gorbonos, Alex; Uchio, Edward; Skinner, Eila C.; Soodana‐Prakash, Nachiketh; Becerra, Maria F.; Swain, Sanjaya; kendrick, Kerri; Smith, Joseph A.; Thompson, Ian M.; Parekh, Dipen J.

doi:10.1097/ju.0000000000000565

Cited by 94 publications

(55 citation statements)

References 15 publications

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“…The RAZOR trial, which compared RARC and ORC in a randomized controlled trial, found no increase in disseminated recurrences. Although the updated 3‐year follow‐up data of RAZOR trial were published, the observed period was still not enough, and further investigation is required . In addition, the fact that there are different results depending on whether the disseminated recurrence increases after MIRC, the recurrence might be directly related to the surgeon’s skill, and the surgeon should be careful not to cause disseminated recurrence.…”

Section: Discussionmentioning

confidence: 99%

Oncological outcomes and recurrence patterns after laparoscopic radical cystectomy for bladder cancer: A Japanese multicenter cohort

et al. 2020

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Objective To investigate oncological outcomes and recurrence patterns after laparoscopic radical cystectomy for bladder cancer in a Japanese multicenter cohort, and to explore the risk factors associated with recurrences due to tumor dissemination. Method Laparoscopic radical cystectomies carried out at 10 institutions were included in this retrospective study. Multivariate analyses were carried out to identify the clinical parameters associated with overall recurrences together with specific recurrence types. Kaplan–Meier curves were created to elucidate time to recurrence and survival. Results A total of 411 patients were included after the final analysis. Postoperative pathology was T2 or higher in 196 patients (48%), and lymph node metastasis was present in 46 patients (11%). The median follow‐up period was 23 months, and the 2‐year recurrence‐free and cancer‐specific survival rates were 71.0% and 84.7%, respectively. The recurrence sites involved distant metastasis in 75 patients (18%), local recurrence in 52 patients (13%) and urinary tract recurrence in eight patients (2%). When local recurrence at the cystectomy bed (28 patients; 7%) and abdominal recurrence including peritoneal carcinomatosis or port site recurrence (17 patients; 4%), which might be caused by tumor dissemination, were combined into a single group, prolonged surgical time was a significant risk factor, in addition to high pathological stage (T3–4 and/or positive lymph nodes), positive surgical margins, and variant histology by both univariate and multivariate analyses. Conclusions Our study findings suggest that recurrences after laparoscopic radical cystectomy might be caused by tumor dissemination, and attention should be paid to avoid prolonged surgical time in laparoscopic radical cystectomy.

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Section: Discussionmentioning

confidence: 99%

Oncological outcomes and recurrence patterns after laparoscopic radical cystectomy for bladder cancer: A Japanese multicenter cohort

et al. 2020

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“…In the two RCTs that compared the outcomes of RARC and ORC, there were no significant differences in nodal yields and the incidence of pN+ patients (Table 3). 85,86 Local recurrence rates were slightly higher in the RARC group without statistical significance 87,88 . In contrast, in a retrospective study using a large‐scale database, nodal yields were significantly greater in RARC than in ORC (Table 3).…”

Section: Other Relevant Issuesmentioning

confidence: 89%

Lymph node dissection for bladder cancer: Current standards and the latest evidence

Nakagawa

2020

Int J of Urology

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Lymph node dissection is an indispensable component of radical cystectomy for bladder cancer. Information obtained with lymph node dissection is highly predictive of patient survival, affecting decision‐making for adjuvant therapy (diagnostic role). Also, lymph node dissection provides survival benefits in certain patients by removing metastasized nodes (therapeutic role). However, an optimal extent of lymph node dissection has not been established yet. Data from surgical mapping studies showed that approximately 10% of the primary lymphatic landing sites were common iliac nodes, suggesting that lymph node dissection below the common iliac bifurcation is suboptimal. Several retrospective studies have shown a possible survival advantage with more extended lymph node dissection. However, the results of the first prospective randomized controlled trial failed to prove the survival advantage of extended lymph node dissection up to the level of the inferior mesenteric artery, compared with lymph node dissection below the bifurcation of the common iliac artery. Currently, lymph node dissection templates recommended by major guidelines are not consistent with each other. Furthermore, the evidence is limited in the settings of neoadjuvant chemotherapy, robot‐assisted surgery and high‐risk non‐muscle‐invasive disease. Physicians need to decide the extent of lymph node dissection for each patient, taking into account the potential survival benefit and possible harms of extended lymph node dissection. Another randomized controlled trial is currently underway and will provide further evidence shortly.

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“…The RAZOR trial [ 8 ] revealed that RARC was non-inferior to ORC for 2-year progression-free survival (PFS). Its update still showed no difference in recurrence, 3-year PFS and 3-year OS between RARC and ORC [ 25 ]. Bochner et al.…”

Section: Discussionmentioning

confidence: 99%

Survival after radical cystectomy for bladder cancer: Multicenter comparison between minimally invasive and open approaches

Xie

Wang

et al. 2020

Asian Journal of Urology

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Objective To investigate oncological outcomes in patients with bladder cancer who underwent minimally invasive radical cystectomy (MIRC) or open radical cystectomy (ORC). Methods We identified patients with bladder cancer who underwent radical cystectomy (RC) in 13 centers of the Chinese Bladder Cancer Consortium (CBCC). Perioperative outcomes were compared between MIRC and ORC. The influence of surgical approaches on overall survival (OS) and cancer-specific survival (CSS) in the entire study group and subgroups classified according to pathologic stage or lymph node (LN) status was assessed with the log-rank test. Multivariable Cox proportional hazard models were used to evaluate the association among OS, CSS and risk factors of interest. Results Of 2 098 patients who underwent RC, 1 243 patients underwent MIRC (1 087 laparoscopic RC and 156 robotic-assisted RC, respectively), while 855 patients underwent ORC. No significant differences were noted in positive surgical margin rate and 90-day postoperative mortality rate. MIRC was associated with less estimated blood loss, more LN yield, higher rate of neobladder diversion, longer operative time, and longer length of hospital stay. There was no significant difference in OS and CSS according to surgical approaches ( p =0.653, and 0.816, respectively). Subgroup analysis revealed that OS and CSS were not significantly different regardless of the status of extravesical involvement or LN involvement. Multivariable Cox regression analyses showed that the surgical approach was not a significant predictor of OS and CSS. Conclusions Our study showed that MIRC was comparable to conventional ORC in terms of OS and CSS.

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Predictors of Recurrence, and Progression-Free and Overall Survival following Open versus Robotic Radical Cystectomy: Analysis from the RAZOR Trial with a 3-Year Followup

Cited by 94 publications

References 15 publications

Oncological outcomes and recurrence patterns after laparoscopic radical cystectomy for bladder cancer: A Japanese multicenter cohort

Oncological outcomes and recurrence patterns after laparoscopic radical cystectomy for bladder cancer: A Japanese multicenter cohort

Lymph node dissection for bladder cancer: Current standards and the latest evidence

Survival after radical cystectomy for bladder cancer: Multicenter comparison between minimally invasive and open approaches

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