PATTERNS OF BLADDER CANCER RECURRENCE AFTER OPEN AND ROBOTIC RADICAL CYSTECTOMY: A CONTEMPORARY SINGLE CENTER EXPERIENCE
Introduction and Objective
There is some concern that patterns of recurrence after robotic-assisted radical cystectomy (RARC) for bladder cancer may be different compared to open radical cystectomy (ORC) due to prolonged pneumoperitoneum and potential cancer cell seeding. The objective of this study was to compare rates and patterns of recurrence after ORC versus RARC with intra-corporeal urinary diversion (ICUD) in a large contemporary cystectomy series.
We performed a retrospective review of 837 consecutive patients who underwent ORC (n=598) or RARC with ICUD (n=238) for bladder cancer between August 2009 to October 2016. Recurrences were classified as local, distant or secondary urothelial carcinomas. Kaplan-Meier method was used for recurrence-free survival (RFS) estimates. Multivariate Cox regression models were used to determine the impact of surgical technique on the risk of recurrence. Two-year recurrence patterns were assessed.
Patients with RARC with ICUD were more likely to have ileal conduit urinary diversion (64% vs 29%, p<0.01), and have extravesical disease (38% vs 30%, p=0.03) but no differences in age (70.1 vs 69.7y), BMI (27.6 vs 27.3), ASA>2 (79.8% vs 73.6%), neoadjuvant chemotherapy (24% vs 29%), CIS (44.3% vs 48.7%), lymphovascular invasion (LVI, 29% vs 26%), or positive surgical margins (PSM, 1.3% vs 1.2%). There was no difference in RFS for the entire cohort (Figure 1), and also by pathological stage: organ confined disease (pT0-pT2, n=565), extra-vesical disease (pT3-pT4, n=270) and node-positive disease (pN+, n=183). On multivariate Cox regression analysis, RARC with ICUD was not an independent predictor of recurrence after adjusting for age, sex, perioperative chemotherapy, pathological tumor and nodal stage, LVI and PSMs (HR 1.05, 95% CI 0.75–1.48; p = 0.8). There were no differences in the number or patterns of local or distant recurrences within 2 years between ORC and RARC (p=0.6), in particular, with respect to peritoneal carcinomatosis and extra-pelvic lymph node metastasis.
This large contemporary series suggests that surgical technique is not an independent predictor of recurrence after radical cystectomy for bladder cancer. These data show no differences in the rates or patterns of local or distant recurrence between ORC and RARC with ICUD.
robotic-assisted radical cystectomy; bladder cancer; uro-oncology.
University of Southern California - - Estados Unidos
Pedro Glusman Knijnik, Pietro Waltrick Brum, Akbar N Ashrafi, Nieroshan Rajarubendra, Andre Abreu, Siamak Daneshmand, Monish Aron, Inderbir S Gill, Mihir M Desai, Andre K Berger