Robot-Assisted Partial Cystectomy versus Open Partial Cystectomy for Patients with Urachal Cancer

Abstract

<b><i>Introduction:</i></b> Localized urachal cancer (UrC) can be treated with an open partial cystectomy (OPC) with en bloc resection of the urachal remnant and umbilicus. Robot-assisted partial cystectomy (RAPC) is an alternative approach, of which its safety and efficacy for UrC remains to be determined. In the present study, we analyze these outcomes after RAPC, compared with OPC. <b><i>Methods:</i></b> We retrospectively evaluated 55 cN0M0 UrC patients who underwent RAPC (<i>n</i> = 8) or OPC (<i>n</i> = 47) between 1994 and 2020. Overall survival (OS) and recurrence-free survival (RFS) were assessed using Kaplan-Meier methods. Positive surgical margins (PSM), port-site recurrences (PSR) versus wound recurrences were compared. Complications were recorded using the Clavien-Dindo classification. <b><i>Results:</i></b> Median follow-up was 40 months (IQR 21–95). Two-year OS and RFS for RAPC were 73% (95% confidence intervals (CI); 56–89 months) and 60% (95% CI; 42–78 months), respectively, versus 90% (95% CI; 85–95 months) and 66% (95% CI; 59–73 months) for OPC. PSM rate was 13% in both groups. PSR occurred in 2/8 (25%) patients after RAPC. No wound recurrences occurred after OPC. Postoperative complications occurred in 2/8 (25%) patients after RAPC, versus 5/47 (11%) after OPC (<i>p</i> = 0.27). <b><i>Conclusion:</i></b> Both RAPC and OPC seem feasible surgical modalities to treat localized UrC with comparable survival. The PSR rate of 25% after RAPC should prompt us to be cautious to recommend RAPC as no such recurrences were seen using OPC.

Robotic‐assisted approaches to urachal carcinoma: A comprehensive systematic review of the safety and efficacy outcomes

“…The studies conducted by Madeb (2006), James (2015) and Stokkel (2022) highlight the oncological efficacy and perioperative safety of robotic surgery as the minimally invasive treatment of choice for patients with UrC, improving surgical outcomes and reducing morbidity. [12][13][14] Robotic-assisted cystectomy remains the technique's principles of open surgery with complete excision of the urachus, umbilicus and pelvic lymphadenectomy 16,17 with the benefits of precise dissection and resection, minimal blood loss and reduced hospitalisation time. [12][13][14][15][16] However, it is essential to manage the tumours carefully and to be cautious when removing the specimens, thus avoiding the implantation of tumour cells in the trocar sites, as evidenced by Stokkel.…”

“…[12][13][14] Robotic-assisted cystectomy remains the technique's principles of open surgery with complete excision of the urachus, umbilicus and pelvic lymphadenectomy 16,17 with the benefits of precise dissection and resection, minimal blood loss and reduced hospitalisation time. [12][13][14][15][16] However, it is essential to manage the tumours carefully and to be cautious when removing the specimens, thus avoiding the implantation of tumour cells in the trocar sites, as evidenced by Stokkel. 14 Mantica et al (2020) highlight the potential underreporting of such recurrences, suggesting a publication bias that may skew data to centres reporting favourable results.…”

“…Patients who underwent robotic surgery presented a median age of 60 years, with a range from 42 to 79 years, 5 men and 3 women. 14 The Madeb study conducted between January 2005 and All patients presented with hematuria, dysuria or urinary mucus. Preoperative evaluation included MRI and CT scans with mass in the dome or anterior bladder wall.…”

“…There was only one case of persistent urinary leak for which the indwelling catheter was successfully left in place for a more extended time. 14 Stokkel et al described two port sites recurrences post robotassisted partial cystectomy. The author utilized positron emission tomography-computed tomography (PET-CT) with fluorodeoxyglucose (FDG) to identify an umbilical lesion at the anterior port site of the robotic trocar, which biopsy confirmed as a metastatic UrC tract.…”

“…The author utilized positron emission tomography-computed tomography (PET-CT) with fluorodeoxyglucose (FDG) to identify an umbilical lesion at the anterior port site of the robotic trocar, which biopsy confirmed as a metastatic UrC tract. 14 In the first case, subsequent to the FDG-PET-CT imaging, the patient underwent a secondary diagnostic laparoscopy. This Kaplan-Meier analysis revealed no significant difference in recurrence-free survival between patients undergoing robot-assisted surgery and open partial cystectomy.…”