Rates and Patterns of Recurrences and Survival Outcomes after Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium

No AccessJournal of UrologyAdult Urology1 Feb 2021Rates and Patterns of Recurrences and Survival Outcomes after Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium Ahmed S. Elsayed, Sean Gibson, Zhe Jing, Carl Wijburg, Andrew A. Wagner, Alexandre Mottrie, Prokar Dasgupta, James Peabody, Ahmed A. Hussein, and Khurshid A. Guru Ahmed S. ElsayedAhmed S. Elsayed Roswell Park Comprehensive Cancer Research Center, Buffalo, New York , Sean GibsonSean Gibson Roswell Park Comprehensive Cancer Research Center, Buffalo, New York , Zhe JingZhe Jing Roswell Park Comprehensive Cancer Research Center, Buffalo, New York , Carl WijburgCarl Wijburg Rijnstate Hospital- Stichting, Arnhem, Arnhem, the Netherlands , Andrew A. WagnerAndrew A. Wagner Beth Israel Deaconess Medical Center, Boston, Massachusetts , Alexandre MottrieAlexandre Mottrie Orsi Academy/OLVZ (Onze-Lieve-Vrouwziekenhuis Ziekenhuis) Aalst, Aalst, Belgium , Prokar DasguptaProkar Dasgupta Guy's Hospital, London, UK , James PeabodyJames Peabody Henry Ford Health System, Detroit, Michigan , Ahmed A. HusseinAhmed A. Hussein Roswell Park Comprehensive Cancer Research Center, Buffalo, New York , and Khurshid A. GuruKhurshid A. Guru Roswell Park Comprehensive Cancer Research Center, Buffalo, New York View All Author Informationhttps://doi.org/10.1097/JU.0000000000001380AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: There have been concerns about higher incidence of local and retroperitoneal recurrences after robot-assisted radical cystectomy compared to open radical cystectomy. We report and detail relapses following robot-assisted radical cystectomy using a multinational database. Materials and Methods: A retrospective review of the International Robotic Cystectomy Consortium was performed. Data were reviewed for demographics, and perioperative, pathological and oncologic outcomes. Relapse rates and patterns were analyzed. Kaplan-Meier curves were used to depict relapse-free, local recurrence-free, distant metastasis-free and overall survival. Kaplan-Meier curves were further stratified by disease stage, lymph node status and margins. Multivariate stepwise Cox regression models were used to identify variables associated with relapse-free, local recurrence-free, distant metastasis-free and overall survival. Results: Of 2,107 patients 521 (25%) experienced disease relapse. Mean age (SD) was 68±10 years with a median followup of 26 (IQR 11–55) months for the study cohort. Local recurrences were observed in 11% and distant metastases in 18%. Early oncologic failure (within 3 months) occurred in 4% of patients. The most common sites of local recurrence and distant metastasis were the pelvis (5%) and lungs (6%)/extrapelvic lymph nodes (5%), respectively. Abdominal wall/port site metastasis occurred in 1.2% and peritoneal carcinomatosis in 1.2%. Five-year relapse-free, local recurrence-free, distant metastasis-free and overall survival was 66%, 84%, 74% and 60%, respectively. Patients with higher disease stage, positive lymph nodes and positive soft tissue surgical margins demonstrated worse relapse-free, local recurrence-free, distant metastasis-free and overall survival (log rank p <0.01 for all comparisons). Multivariate regression models identified that node positive status and disease stage (pT3 or greater) were significantly associated with relapse-free, local recurrence-free, distant metastasis-free and overall survival (p <0.01). Conclusions: Disease stage remains the main variable associated with disease relapse and survival following radical cystectomy. Robot-assisted radical cystectomy was not associated with different patterns or higher relapse rates compared to historic open radical cystectomy data. References 1. : SEER Cancer Statistics Review, 1975-2016; 1423-37. Bethesda, Maryland:National Cancer Institute 2019. Available at https://seer.cancer.gov/csr/1975_2016/. Google Scholar 2. : Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol 2001; 19: 666. Google Scholar 3. : Nerve-sparing robot-assisted radical cystoprostatectomy and urinary diversion. BJU Int 2003; 92: 232. Google Scholar 4. : The changing face of urologic oncologic surgery from 2000-2018 (63 141 patients)-impact of robotics. Eur Urol Suppl 2019; 18: e656. Google Scholar 5. : Phase III randomized trial of laparoscopic or robotic versus abdominal radical hysterectomy in patients with early-stage cervical cancer: LACC trial. Gynecol Oncol 2018; 149: 245. Google Scholar 6. : Pneumoperitoneum with carbon dioxide inhibits macrophage tumor necrosis factor-α secretion: source of transitional-cell carcinoma port-site metastasis, with prophylactic irrigation strategies to decrease laparoscopic oncologic risks. J Endourol 2008; 22: 105. Google Scholar 7. : Recurrence patterns after open and robot-assisted radical cystectomy for bladder cancer. Eur Urol 2015; 68: 399. Google Scholar 8. : Adverse surgical outcomes associated with robotic retroperitoneal lymph node dissection among patients with testicular cancer. Eur Urol 2019; 76: 607. Google Scholar 9. : Early oncologic failure after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. J Urol 2017; 197: 1427. Link, Google Scholar 10. : Does aggressiveness of tumor stage correlate with intra-operative pelvic washings & pneumo-peritoneum during robot-assisted radical cystectomy? (abstract MP88-13). J Urol, suppl., 2017; 197: e1178. Link, Google Scholar 11. : Re: Daniel P. Nguyen, Bashir Al Hussein Al Awamlh, Xian Wu, et al. Recurrence patterns after open and robot-assisted radical cystectomy for bladder cancer. Eur Urol 2015;68:399–405. Eur Urol 2016; 69: e35. Google Scholar 12. : Port-site metastases after robotic radical cystectomy: a systematic review and management options. Clin Genitourin Cancer 2017; 15: 440. Google Scholar 13. : Randomized trial comparing open radical cystectomy and robot-assisted laparoscopic radical cystectomy: oncologic outcomes. Eur Urol 2018; 74: 465. Google Scholar 14. : Radical cystectomy for bladder cancer today—a homogeneous series without neoadjuvant therapy. J Clin Oncol 2003; 21: 690. Google Scholar 15. : Radical cystectomy for carcinoma of the bladder: 2,720 consecutive cases 5 years later. J Urol 2008; 180: 121. Link, Google Scholar 16. : Predictors of recurrence, and progression-free and overall survival following open versus robotic radical cystectomy: analysis from the RAZOR trial with a 3-year followup. J Urol 2020; 203: 522. Link, Google Scholar 17. : A single-centre early phase randomised controlled three-arm trial of open, robotic, and laparoscopic radical cystectomy (CORAL). Eur Urol 2016; 69: 613. Google Scholar 18. : Ten-year oncologic outcomes following robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. J Urol 2019; 202: 927. Link, Google Scholar 19. : Complications after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium. Eur Urol 2013; 64: 52. Google Scholar 20. : Quality of care in bladder cancer: trends in urinary diversion following radical cystectomy. World J Urol 2009; 27: 45. Google Scholar 21. : Robot-assisted radical cystectomy with intracorporeal urinary diversion versus open radical cystectomy (iROC): protocol for a randomised controlled trial with internal feasibility study. BMJ open 2018; 8: e020500. Google Scholar 22. : Hydronephrosis as a prognostic marker in bladder cancer in a cystectomy-only series. Eur Urol 2007; 51: 690. Google Scholar 23. : The effect of cystectomy, and perioperative methotrexate, vinblastine, doxorubicin and cisplatin chemotherapy on the risk and pattern of relapse in patients with muscle invasive bladder cancer. J Urol 2000; 163: 1413. Link, Google Scholar 24. : The impact of perioperative blood transfusion on cancer recurrence and survival following radical cystectomy. Eur Urol 2013; 63: 839. Google Scholar 25. : Neoadjuvant chemotherapy is not associated with adverse perioperative outcomes after robot-assisted radical cystectomy: a case for increased use from the IRCC. J Urol 2020; 203: 57. Link, Google Scholar 26. : Soft tissue surgical margin status is a powerful predictor of outcomes after radical cystectomy: a multicenter study of more than 4,400 patients. J Urol 2010; 183: 2165. Link, Google Scholar 27. : Perioperative and oncological outcomes of robot-assisted radical cystectomy in octogenarians. J Geriatr Oncol 2020; 11: 727. Google Scholar Supported by Roswell Park Alliance Foundation and Vattikuti Foundation Collective Quality Initiative. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Editor's Note: This article is the first of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 639 and 640. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 205Issue 2February 2021Page: 407-413Supplementary Materials Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.Keywordsrecurrencerobotic surgical procedurescystectomyneoplasm metastasisurinary bladder neoplasmsAcknowledgmentsBertram Yuh, Juan Palou, Ahmed Aboumohamed, Eric Kim, Morgan Roupret, Ketan K. Badani, Peter Wiklund, Derya Balbay, Vassilis Poulakis, Thomas J. Maatman, Nikhil Vasdev, Dimitrios Moschonas, John Kelly, Koon Ho Rha, Franco Gaboardi, Michael Stockle, Mohammad Shamim Khan, Lee Richstone, Abolfazl Hosseini, Mani Menon, Jihad Kaouk and Qiang Li contributed to the study.MetricsAuthor Information Ahmed S. Elsayed Roswell Park Comprehensive Cancer Research Center, Buffalo, New York Equal study contribution. More articles by this author Sean Gibson Roswell Park Comprehensive Cancer Research Center, Buffalo, New York Equal study contribution. More articles by this author Zhe Jing Roswell Park Comprehensive Cancer Research Center, Buffalo, New York More articles by this author Carl Wijburg Rijnstate Hospital- Stichting, Arnhem, Arnhem, the Netherlands More articles by this author Andrew A. Wagner Beth Israel Deaconess Medical Center, Boston, Massachusetts More articles by this author Alexandre Mottrie Orsi Academy/OLVZ (Onze-Lieve-Vrouwziekenhuis Ziekenhuis) Aalst, Aalst, Belgium More articles by this author Prokar Dasgupta Guy's Hospital, London, UK More articles by this author James Peabody Henry Ford Health System, Detroit, Michigan More articles by this author Ahmed A. Hussein Roswell Park Comprehensive Cancer Research Center, Buffalo, New York More articles by this author Khurshid A. Guru Roswell Park Comprehensive Cancer Research Center, Buffalo, New York Equal study contribution. More articles by this author Expand All Supported by Roswell Park Alliance Foundation and Vattikuti Foundation Collective Quality Initiative. No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Editor's Note: This article is the first of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 639 and 640. Advertisement PDF DownloadLoading ...