The feasibility and effectiveness of robot-assisted radical cystectomy after neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer

Abstract

Objectives: The aim of this study was to compare 29 muscle-invasive bladder cancer patients who received neoadjuvant chemotherapy (NAC) followed by immediate robot-assisted radical cystectomy (RARC) with those who underwent minimum-incision endoscopic RC (MIE-RC). Methods: We retrospectively reviewed the charts of 430 consecutive patients who underwent RC and bilateral pelvic node dissection (PLND) between May 1994 and July 2016. Our study focused on patients with MIBC who had histologically confirmed stage T2-T4aN0M0 urothelial carcinoma of the bladder and received NAC prior to surgery. Accordingly, 225 patients were included in this analysis, of whom, 29 underwent RARC (RARC group) and 196 underwent MIE-RC (MIE-RC group). The primary endpoints in this study were the positive surgical margin (PSM) rate and lymph node (LN) count. Results: In the RARC group, 20 patients underwent RARC with intracorporeal urinary diversion and nine patients underwent RARC with extracorporeal urinary diversion. The median surgical duration for RC and bilateral PLND was 125 min in the RARC group and 98 min in the MIE-RC group (P < 0.001). The rate of PSM was 0% in the RARC group and 0.5% in the MIE-RC group. The median LN counts were 15 in the RARC group and 18 in the MIE-RC group. No intra-operative complication or mortality was associated with RARC or MIE-RP. All complications were grade 2 according to the Clavien-Dindo classification. Conclusions: Our initial experience with NAC followed by RARC appears to be favorable, with acceptable operative and perioperative clinical outcomes when compared with those of MIE-RC.

Surgery after neoadjuvant chemotherapy for muscle invasive bladder cancer: clinicopathological and surgical outcomes

“…All 29 patients, however were node negative (100%). 16 In this study, MVAC regimen was used in ten patients (45.5%), GC protocol in eight patients (36.3%) and G/carbo in four patients (18.2%). While in American study, among 106 patients, they used MVAC in 11 patients (10%) and GC in 95 patients (90%).…”

Utility of robot‐assisted radical cystectomy with intracorporeal urinary diversion for muscle‐invasive bladder cancer

“…MIBC is a systematic disease with distant metastases, lymph node involvement and local recurrence often caused by micrometastases at the time of diagnosis. Therefore, early systemic therapy is important for eradication of the risk of micrometastases outside the surgical field …”

“…In contrast, few studies have investigated the utility and efficacy of NAC in patients with MIBC who underwent RARC . Hinata et al .…”

“…In addition, there were no significant differences in DFS and OS between the suboptimal NAC and no NAC groups . In our previous study, we evaluated 29 MIBC patients who received NAC followed by RARC and compared results with those of patients treated by MIE‐RC . In the RARC cohort, four patients (13.8%) showed a complete response, four (13.8%) showed a partial response and two (6.9%) showed stable disease (Table ).…”

“…Conversely, RARC has technical advantages over LRC, such as magnified 3‐D vision with a surgeon‐controlled camera, mechanical wrists with seven degrees of motion, motion scaling and tremor reduction . Therefore, RARC has emerged as a better alternative to ORC because of its possible reduction in EBL, blood transfusion rate and postoperative analgesia, and quicker recovery of bowel function …”