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

被引:51
作者
Hussein, Ahmed A. [1 ]
Elsayed, Ahmed S. [1 ]
Aldhaam, Naif A. [1 ]
Jing, Zhe [1 ]
Osei, Jennifer [1 ]
Kaouk, Jihad [3 ]
Redorta, Juan Palou [4 ]
Menon, Mani [5 ]
Peabody, James [5 ]
Dasgupta, Prokar [6 ,7 ]
Khan, Mohammed Shamim [6 ,7 ]
Mottrie, Alexandre [8 ]
Stoeckle, Michael [9 ]
Hemal, Ashok [10 ]
Richstone, Lee [2 ]
Hosseini, Abolfazl [11 ]
Wiklund, Peter [11 ]
Schanne, Francis [12 ]
Kim, Eric [13 ]
Rha, Koon Ho [14 ]
Guru, Khurshid A. [1 ]
机构
[1] Roswell Park Comprehens Canc Ctr, New York, NY USA
[2] Arthur Smith Inst Urol, New York, NY USA
[3] Cleveland Clin, Glickman Urol & Kidney Inst, Cleveland, OH 44106 USA
[4] Fundacio Puigvert, Barcelona, Spain
[5] Henry Ford Hlth Syst, Detroit, MI USA
[6] Guys Hosp, London, England
[7] Kings Coll London, Sch Med, London, England
[8] Onze Lieve Vrouw Hosp, Aalast, Belgium
[9] Univ Saarland, Homburg Saar, Germany
[10] Wake Forest Univ, Baptist Med Ctr, Winston Salem, NC 27101 USA
[11] Karolinska Inst, Stockholm, Sweden
[12] Urol Surg Associates Delaware, Wilmington, DE USA
[13] Washington Univ, Sch Med, St Louis, MO USA
[14] Yonsei Med Hlth Syst, Seoul, South Korea
关键词
urinary bladder neoplasms; cystectomy; robotic surgical procedures; recurrence; mortality; BLADDER-CANCER; SURGICAL MARGINS; NEOADJUVANT; CARCINOMA;
D O I
10.1097/JU.0000000000000386
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
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.
引用
收藏
页码:929 / 936
页数:8
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