Early oncological outcomes for bladder urothelial carcinoma patients treated with robotic-assisted radical cystectomy

OBJECTIVE To determine oncological outcomes including early survival rates among unselected bladder urothelial carcinoma (BUC) patients treated with robotic-assisted radical cystectomy (RRC). PATIENTS AND METHODS Clinicopathologic and survival data were prospectively gathered for 85 consecutive BUC patients treated with RRC. The decision to undergo a robotic rather than open approach was made without regard to tumor volume or surgical candidacy. Kaplan-Meier survival rates were determined and stratified by tumor stage and LN positivity, and multivariate analysis was performed to identify independent predictors of survival. RESULTS Patients were relatively old (25% > 80 years; median 73.5 years), with frequent comorbidities (46% with ASA class >= 3). Of these patients 28% had undergone previous pelvic radiation or pelvic surgery, and 20% had received neoadjuvant chemotherapy. Extended pelvic lymphadenectomy was performed in 98% of patients, with on average 19.1 LN retrieved. On final pathology, extravesical disease was common (36.5%). Positive surgicalmargins were detected in five (6%) patients, all of whom had extravesical tumors with perineural and/or lymphovascular invasion, and most of whom were > 80 years old. At a mean postoperative interval of 18 months, 20 (24%) patients had developed recurrent disease, but only three (4%) patients had recurrence locally. Disease-free, cancer-specific and overall survival rates at 2 years were 74%, 85% and 79%, respectively. Patients with low-stage/LN(-) cancers had significantly better survival than extravesical/LN(-) or any-stage/LN(+) patients, with stage being the most important predictor on multivariate analysis. CONCLUSION RRC can achieve adequately high LN yields with a low positive margin rate among unselected BUC patients. Early survival outcomes are similar to those reported in contemporary open series, with an encouragingly low incidence of local recurrence, however long-term follow-up and head-to-head comparison with the open approach are still needed.