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

 Ahmed A. Hussein  ;  Matthias Saar  ;  Paul R. May  ;  Carl J. Wijburg  ;  Lee Richstone  ;  Andrew Wagner  ;  Timothy Wilson  ;  Bertram Yuh  ;  Joan Palou Redorta  ;  Prokar Dasgupta  ;  Mohammad Shamim Khan  ;  Mani Menon  ;  James O. Peabody  ;  Abolfazl Hosseini  ;  Franco Gaboardi  ;  Alexandre Mottrie  ;  Koon-ho Rha  ;  Ashok Hemal  ;  Michael Stockle  ;  John Kelly  ;  Thomas J. Maatman  ;  Abdullah Erdem Canda  ;  Peter Wiklund  ;  Khurshid A. Gur 
 JOURNAL OF UROLOGY, Vol.197(6) : 1427-1436, 2017 
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cystectomy ; local ; neoplasm recurrence ; robotic surgical procedures ; treatment failure ; urinary bladder neoplasms
PURPOSE: We sought to investigate the prevalence and variables associated with early oncologic failure. MATERIALS AND METHODS: We retrospectively reviewed the IRCC (International Radical Cystectomy Consortium) database of patients who underwent robot-assisted radical cystectomy since 2003. The final cohort comprised a total of 1,894 patients from 23 institutions in 11 countries. Early oncologic failure was defined as any disease relapse within 3 months of robot-assisted radical cystectomy. All institutions were surveyed for the pneumoperitoneum pressure used, breach of oncologic surgical principles, and techniques of specimen and lymph node removal. A multivariate model was fit to evaluate predictors of early oncologic failure. The Kaplan-Meier method was applied to depict disease specific and overall survival, and Cox proportional regression analysis was used to evaluate predictors of disease specific and overall survival. RESULTS: A total of 305 patients (22%) experienced disease relapse, which was distant in 220 (16%), local recurrence in 154 (11%), peritoneal carcinomatosis in 17 (1%) and port site recurrence in 5 (0.4%). Early oncologic failure developed in 71 patients (5%) at a total of 10 institutions. The incidence of early oncologic failure decreased from 10% in 2006 to 6% in 2015. On multivariate analysis the presence of any complication (OR 2.87, 95% CI 1.38-5.96, p = 0.004), pT3 or greater disease (OR 3.73, 95% CI 2.00-6.97, p <0.001) and nodal involvement (OR 2.14, 95% CI 1.21-3.80, p = 0.008) was a significant predictor of early oncologic failure. Patients with early oncologic failure demonstrated worse disease specific and overall survival (23% and 13%, respectively) at 1 and 3 years compared to patients who experienced later or no recurrences (log rank p <0.001). CONCLUSIONS: The incidence of early oncologic failure following robot-assisted radical cystectomy has decreased with time. Disease related rather than technical related factors have a major role in early oncologic failure after robot-assisted radical cystectomy.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Rha, Koon Ho(나군호) ORCID logo https://orcid.org/0000-0001-8588-7584
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