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Oncological outcome according to attainment of pentafecta after robot-assisted radical cystectomy in patients with bladder cancer included in the multicentre KORARC database

 Jong Jin Oh  ;  Sangchul Lee  ;  Ja Hyeon Ku  ;  Tae Gyun Kwon  ;  Tae-Hwan Kim  ;  Seung Hyun Jeon  ;  Sang Hyup Lee  ;  Jong Kil Nam  ;  Wan Seok Kim  ;  Byong Chang Jeong  ;  Ji Youl Lee  ;  Sung Hoo Hong  ;  Koon Ho Rha  ;  Woong Kyu Han  ;  Won Sik Ham  ;  Young Goo Lee  ;  Yong Seong Lee  ;  Sung Yul Park  ;  Young Eun Yoon  ;  Sung Gu Kang  ;  Seok Ho Kang 
 BJU INTERNATIONAL, Vol.127(2) : 182-189, 2021-02 
Journal Title
Issue Date
Cystectomy / methods* ; Databases, Factual ; Disease-Free Survival ; Female ; Follow-Up Studies ; Humans ; Incidence ; Male ; Middle Aged ; Neoplasm Staging / methods ; Operative Time ; Postoperative Complications / epidemiology* ; Prognosis ; Republic of Korea / epidemiology ; Retrospective Studies ; Risk Factors ; Robotic Surgical Procedures / methods* ; Survival Rate / trends ; Urinary Bladder / diagnostic imaging ; Urinary Bladder / surgery* ; Urinary Bladder Neoplasms / diagnosis ; Urinary Bladder Neoplasms / mortality ; Urinary Bladder Neoplasms / surgery*
Bladder Cancer ; blcsm ; uroonc ; bladder cancer ; robot cystectomy ; survival
Objectives: To investigate the oncological significance of a robot-assisted radical cystectomy (RARC)-related pentafecta in patients with bladder cancer.

Patients and methods: Using the KORARC database, which includes data from 12 centres, data from 730 patients who underwent RARC between April 2007 and May 2019 were prospectively collected and retrospectively analysed. Pentafecta was achieved if patients met all of the following criteria: (i) negative soft tissue surgical margin; (ii) ≥16 lymph nodes removed; (iii) no major complications (Clavien-Dindo grade 3-5) within 90 days; (iv) no clinical recurrence within the first 12 months; and (v) no ureteroenteric stricture. Patients were divided into two groups according to pentafecta attainment, and a comparison of overall survival (OS) and cancer-specific survival (CSS) using multivariate Cox proportional analysis was then carried out.

Results: Of the 730 patients included in this analysis, 208 (28.5%) attained the RARC pentafecta; the remaining 522 (71.5%) did not. The mean age of the patients was 64.67 years, 85.1% were men, 53.6% received a conduit, 37.7% received orthotopic neobladders and the total complication rate was 57.8%. Those who attained the pentafecta received more neobladders (P = 0.039), were more likely to be treated with the intracorporeal technique (P < 0.001), had longer operating times (P = 0.020) and had longer console time (P = 0.021) compared with those who did not attain the pentafecta. Over a mean of 31.1 months of follow-up, the pentafecta attainment group had significantly higher OS and CSS rates compared with the non-attainment group (10-year OS 70.4% vs 58.1%, respectively [P = 0.016]; 10-year CSS 87.8% vs 70.0%, respectively [P = 0.036]). Multivariate analysis showed that the RARC pentafecta was a significant predictor of overall mortality (hazard ratio 0.561; P = 0.038).

Conclusions: Patients who attained the RARC pentafecta had significantly better survival outcomes compared with those who did not. These criteria could be used to standardize assessment of the surgical quality of RARC. In the future, a similar study using an independent cohort is warranted to confirm our results.
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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
Han, Woong Kyu(한웅규) ORCID logo https://orcid.org/0000-0002-2527-4046
Ham, Won Sik(함원식) ORCID logo https://orcid.org/0000-0003-2246-8838
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