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Ten-Year Oncologic Outcomes Following Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium

 Hussein, Ahmed A.  ;  Elsayed, Ahmed S.  ;  Aldhaam, Naif A.  ;  Jing, Zhe  ;  Osei, Jennifer  ;  Kaouk, Jihad  ;  Redorta, Juan Palou  ;  Menon, Mani  ;  Peabody, James  ;  Dasgupta, Prokar  ;  Khan, Mohammed Shamim  ;  Mottrie, Alexandre  ;  Stockle, Michael  ;  Hemal, Ashok  ;  Richstone, Lee  ;  Hosseini, Abolfazl  ;  Wiklund, Peter  ;  Schanne, Francis  ;  Kim, Eric  ;  Ho Rha, Koon  ;  Guru, Khurshid A. 
 JOURNAL OF UROLOGY, Vol.202(5) : 927-935, 2019 
Journal Title
Issue Date
Aged ; Cystectomy/methods* ; Disease-Free Survival ; Europe/epidemiology ; Female ; Follow-Up Studies ; Forecasting* ; Humans ; Incidence ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local/epidemiology* ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Robotic Surgical Procedures/methods* ; Survival Rate/trends ; United States/epidemiology ; Urinary Bladder Neoplasms/mortality ; Urinary Bladder Neoplasms/pathology ; Urinary Bladder Neoplasms/surgery*
cystectomy ; mortality ; recurrence ; robotic surgical procedures ; urinary bladder neoplasms
PURPOSE: Radical cystectomy is the gold standard for nonmetastatic muscle invasive bladder cancer and for refractory nonmuscle invasive disease. Compared to open radical cystectomy, robot-assisted radical cystectomy has been shown to provide comparable early oncologic outcomes and improved perioperative outcomes. However, there is a paucity of data on long-term oncologic outcomes and concerns about a higher incidence of local recurrence after robot-assisted radical cystectomy. We report 10-year oncologic outcomes following robot-assisted radical cystectomy using a multinational database. MATERIALS AND METHODS: We retrospectively reviewed the prospective International Robotic Cystectomy Consortium database. Consecutive patients who underwent robot-assisted radical cystectomy 10 years ago or earlier were included in analysis. Data were reviewed for demographics, and perioperative, pathological and oncologic outcomes. Kaplan-Meier curves were used to depict recurrence-free, disease specific and overall survival. Multivariate stepwise Cox regression models were applied to identify variables associated with recurrence-free, disease specific and overall survival. RESULTS: We identified 446 patients with a median age of 67 years (IQR 59-76). Of the patients 10% received neoadjuvant chemotherapy, 51% experienced any complication, 23% had high grade complications and 4% died within 3 months of robot-assisted radical cystectomy. Disease was pT3 or greater in 43% of patients and pN+ in 24% while a positive soft tissue surgical margin was observed in 7%. At a median followup of 5 years (IQR 2-10, maximum 14) local and distant recurrence had developed in 15% and 29% of patients, respectively. Ten-year recurrence-free, disease specific and overall survival rates were 59%, 65% and 35%, respectively. Patients with pT3 or greater and pN+ disease showed worse recurrence-free, disease specific and overall survival. CONCLUSIONS: Long-term oncologic outcomes, and recurrence rates and patterns after robot-assisted radical cystectomy seem comparable to those in open series. Advanced disease stage and positive surgical margins remain the main determinants of survival after 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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