Bladder cancer recurrence patterns after robotic radical cystectomy with completely intracorporeal urinary diversion : a contemporary comparison with open radical cystectomy at a high-volume academic center

Abstract

Background: There is some debate about patterns of recurrence after robotic radical cystectomy (RARC) for bladder cancer compared to open radical cystectomy (ORC). Objective: To compare rates and patterns of recurrence after RARC with completely intracorporeal urinary diversion (ICUD) and ORC. Design, Setting and Participants: Between August 2009 and June 2016, 837 consecutive patients underwent RARC with ICUD or ORC for localized BC at a single high-volume academic cancer center. Intervention: RARC and ICUD was performed in 237 patients, while ORC was performed in 598 patients. Outcome Measurements and Statistical Analysis: The outcomes of interest were recurrencefree survival (RFS), overall survival (OS) and distrubtion of local and distant recurrence. The patterns of local and distant recurrences within 2 years were tabulated. Kaplan-Meier analysis, the log rank test, and Cox regression analyses were used to compare RFS and OS between the two groups. All data was collected prospectively within an IRB-approved database and analysed retrospectively. All statistical analyses were performed using SAS software. Results and limitations: Both groups were comparable with respect to age, BMI, ASA, neoadjuvant chemotherapy status, CIS, LVI, positive soft-tissue margins and node-positive disease. RARC and ICUD patients were more likely to have an ileal conduit (64% vs 29%, p<0.05) and extravesical disease (38% vs 30%, p<0.05). There was no difference in recurrence-free survival for the entire cohort, and by pathological stage: organ-confined disease (pT0-pT2, n=565), extra-vesical disease (pT3-pT4, n=270) and node-positive disease (pN+, n=183, all p>0.05). Median time to recurrence was 6.9 months in RARC arm and 7.7 months in the ORC arm. On multivariable regression analysis, RARC was not an independent predictor of recurrence after adjusting for confounders (HR 1.05, 95%CI 0.75–1.48; p=0.8). There were no differences in the number or patterns of recurrences, in particular, with respect to peritoneal carcinomatosis and extra-pelvic lymph node metastasis. The main limitation of this study is the retrospective analysis. Conclusions: These contemporary data show no differences in the rates or patterns of local or distant bladder cancer recurrence between ORC and RARC with ICUD. Patient summary: Radical cystectomy and urinary diversion for bladder cancer using the robotic platform is not associated with differences in the rates or patterns of recurrence compared to traditional open surgical techniques.