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Hanna P, Zabell J, Konety B, Warlick C. Perioperative complications and oncological outcomes of open versus robotic-assisted radical cystectomy: a propensity score-matched study. World J Urol 2024; 42:220. [PMID: 38587653 DOI: 10.1007/s00345-024-04907-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Accepted: 02/24/2024] [Indexed: 04/09/2024] Open
Abstract
PURPOSE To conduct a comparative effectiveness analysis between robot-assisted radical cystectomy (RARC) and open approach (ORC). MATERIALS AND METHODS A retrospective cohort study was conducted involving all patients undergoing radical cystectomy and urinary diversion for invasive bladder cancer at our institution from 2010 to 2018. Of a total 296 patients, we matched ORC and RARC cases based on age, BMI, Charlson comorbidity index, pathological TN staging of the tumor, prior radiotherapy, and type of diversion. The perioperative complications and oncological outcomes were compared. RESULTS Eighty-nine patients were matched in the ORC and RARC groups. The median operative time was longer in RARC group (430 min) than that of ORC group (372 min) (p = 0.03); however, the median estimated blood loss (EBL) was significantly lower in RARC group (500 ml) than that of ORC (700 ml) (p < 0.0001). The median length of hospital stay (LOS) was significantly reduced in the RARC group (7 days) compared to the ORC group (8 days) (p = 0.02). There were no significant differences between both groups in 30- and 90-day postoperative complications (p = 0.3 and p = 0.2, respectively). A total of 68 deaths (38.2%) were observed, of which 36 (40.4%) were in ORC group while 32 (36%) were in RARC group (p = 0.5). The results were comparable in both groups regarding 5-year survival rate and cancer-specific survival (p = 0.3 and p = 0.1, respectively). CONCLUSION RARC showed better perioperative outcomes in the form of less EBL and shortened LOS compared to ORC group. However, both RARC and ORC provide similar postoperative oncologic control, in terms of similar positive surgical margins, cancer-specific rates, and 5-year survival rates.
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Affiliation(s)
- Peter Hanna
- Department of Urology, University of Minnesota, Minneapolis, MN, USA.
- Department of Urology, Aswan University, Aswan, Egypt.
| | - Joseph Zabell
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
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Simhal RK, Simon DP, Wang KR, Shah YB, Havranek B, Mark JR, Chandrasekar T, Shah MS, Lallas CD. Perioperative and Complication Related Outcomes for Robotic-Assisted vs Open Radical Cystectomy: A Comparative National Surgical Quality Improvement Project Analysis. J Endourol 2024; 38:331-339. [PMID: 38269428 DOI: 10.1089/end.2023.0279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
Background: Radical cystectomy (RC) is standard of care for muscle-invasive bladder cancer, but it comes with significant perioperative risk, with half of the patients experiencing major postoperative complications. Robot-assisted radical cystectomies (RARCs) have aimed to decrease patient morbidity and been increasingly adopted in North America. Currently, both open radical cystectomies (ORCs) and RARCs are frequently performed. The aim of this study is to contribute to the existing literature using newly available data from the American College of Surgeons National Surgical Quality Improvement Project (NSQIP), representing one of the most recent, largest multi-institutional studies, while uniquely accounting for a variety of factors, including type of urinary diversion, cancer staging, and neoadjuvant chemotherapy. Methods: RC procedures performed between 2019 and 2021 were identified in NSQIP and the corresponding cystectomy-targeted database. Cases in the ORC group were planned open procedures, and cases in the RARC group were robot assisted, including unplanned conversion to open cases for intention to treat. Chi-square and t-tests were performed to compare baseline demographics and operative parameters. Multivariate analysis was performed for outcomes, including major complications, minor complications, and 30-day mortality rates, while adjusting for baseline differences significant on univariate analysis. Results: Five thousand three hundred forty-three RC cases were identified. Of these, 70% underwent planned ORC, while 30% received RARC. RARC was associated with longer operative times and shorter hospital length of stay compared with ORC. On multivariate analysis, there was no difference between the cohorts in 30-day rates of major complications, hospital readmissions, need for reoperation, or mortality. ORC was, however, associated with higher rates of minor complications, bleeding, superficial surgical site infections, and anastomotic leak. Conclusions: In the NSQIP database, ORC is associated with higher rates of 30-day minor complications, most notably bleeding, compared with RARC. However, there is no difference in regard to perioperative major morbidity or mortality rates. This study is unique in the size of the cohorts compared, timeliness of data (2019-2021), applicability to a variety of different practice settings across the country, and ability to control for factors, such as type of urinary diversion and pathological bladder cancer staging, as well as use of neoadjuvant chemotherapy. This study was approved by the Institutional Review Board (IRB) specific to Thomas Jefferson University.
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Affiliation(s)
- Rishabh K Simhal
- Department of Urology, Ochsner Medical Center, New Orleans, Louisiana, USA
| | - Daniel P Simon
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Department of Urology, Intermountain Health Care, Salt Lake City, Utah, USA
| | - Kerith R Wang
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Yash B Shah
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brandon Havranek
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - James R Mark
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Mihir S Shah
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Costas D Lallas
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Sasaki Y, Izumi K, Fukuta K, Kadoriku F, Atagi Y, Daizumoto K, Shiozaki K, Tomida R, Kusuhara Y, Fukawa T, Yanagihara Y, Yamaguchi K, Yamamoto Y, Izaki H, Takahashi M, Okamoto K, Yamanaka M, Furukawa J. Impact of lymph node dissection on surgical and oncological outcomes in patients undergoing robot-assisted radical cystectomy for bladder cancer: a multicenter retrospective study. J Robot Surg 2024; 18:141. [PMID: 38554230 DOI: 10.1007/s11701-024-01893-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 02/28/2024] [Indexed: 04/01/2024]
Abstract
This study was performed to clarify the therapeutic and diagnostic roles of lymph node dissection (LND) by examining the impact of LND and lymph node yield (LNY) on oncological outcomes in patients undergoing robot-assisted radical cystectomy (RARC). Between 2014 and 2021, 216 patients underwent LND during RARC at Tokushima University Hospital and affiliated hospitals. Among the 216 patients, we compared 115 patients with an LNY of ≥ 20 and 101 with an LNY of < 20 to investigate the impact of LNY on surgical and oncological outcomes. Furthermore, we investigated the impact of LNY and the extent of LND on oncological outcomes by dividing the extent of LND into two groups (standard and extended). The 3-year rates of overall survival (OS) (p = 0.256), cancer-specific survival (CSS) (p = 0.791), and recurrence-free survival (RFS) (p = 0.953) did not differ between the two groups divided by the LNY. A higher LNY was associated with a significantly higher lymph node positivity rate (p = 0.020). The incidence of LND-related major complications was not significantly different between the two groups (p = 0.910). The 3-year survival rates did not differ between the two groups divided by the extent of LND: OS (p = 0.366), CSS (p = 0.814), and RFS (p = 0.689). The LNY and extent of LND were not associated with oncological outcomes in patients undergoing LND during RARC, whereas a higher LNY was associated with lymph node positivity. In the era of adjuvant therapy with immune checkpoint inhibitors, LND during RARC has an important diagnostic role in the detection of pathological node positivity.
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Affiliation(s)
- Yutaro Sasaki
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan.
| | - Kazuyoshi Izumi
- Department of Urology, Takamatsu Red Cross Hospital, 4-1-3 Ban-cho, Takamatsu, 760-0017, Japan
| | - Kyotaro Fukuta
- Department of Urology, Tokushima Prefectural Central Hospital, 1-10-3 Kuramoto-cho, Tokushima, 770-8539, Japan
| | - Fumiya Kadoriku
- Department of Urology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, 790-0024, Japan
| | - Yuichiro Atagi
- Department of Urology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, 790-0024, Japan
| | - Kei Daizumoto
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Keito Shiozaki
- Department of Urology, Tokushima Prefectural Central Hospital, 1-10-3 Kuramoto-cho, Tokushima, 770-8539, Japan
| | - Ryotaro Tomida
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Yoshito Kusuhara
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Tomoya Fukawa
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Yutaka Yanagihara
- Department of Urology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, 790-0024, Japan
| | - Kunihisa Yamaguchi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Yasuyo Yamamoto
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Hirofumi Izaki
- Department of Urology, Tokushima Prefectural Central Hospital, 1-10-3 Kuramoto-cho, Tokushima, 770-8539, Japan
| | - Masayuki Takahashi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
| | - Kenjiro Okamoto
- Department of Urology, Ehime Prefectural Central Hospital, 83 Kasuga-machi, Matsuyama, 790-0024, Japan
| | - Masahito Yamanaka
- Department of Urology, Takamatsu Red Cross Hospital, 4-1-3 Ban-cho, Takamatsu, 760-0017, Japan
| | - Junya Furukawa
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, 3-18-15 Kuramoto-cho, Tokushima, 770-8503, Japan
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Fu S, Shi H, Fan Z, Li J, Luan T, Dong H, Wang J, Chen S, Zhang J, Wang J, Ding M, Wang H. Robot-assisted radical cystectomy with intracorporeal urinary diversion: an updated systematic review and meta-analysis of its differential effect on effectiveness and safety. Int J Surg 2024; 110:01279778-990000000-00948. [PMID: 38260944 PMCID: PMC11020008 DOI: 10.1097/js9.0000000000001065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 12/24/2023] [Indexed: 01/24/2024]
Abstract
BACKGROUND Robot-assisted laparoscopic cystectomy with intracorporeal urinary diversion (iRARC) is increasingly being used in recent years. Whether iRARC offers advantages over open radical cystectomy (ORC) remains controversial. This study aimed to compare the difference of perioperative outcomes, oncological outcomes and complications between iRARC and ORC. METHODS The PubMed, Embase, Cochrane Library, Web of Science and CNKI databases were searched in July 2023 according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement. Studies were identified to be eligible if they compared perioperative outcomes, oncological outcomes and complications in patients who underwent iRARC with ORC. RESULTS Twenty-two studies involving 7,020 patients were included. Compared to ORC, iRARC was superior for estimated blood loss [EBL WMD: -555.52; 95% CI, -681.64 to -429.39; P<0.001], blood transfusion rate [OR: 0.16; 95% CI, 0.09 to 0.28; P<0.001], length of hospital stay [LOS WMD: -2.05; 95% CI, -2.93 to -1.17; P<0.001], Clavien-Dindo grades ≥III complication rate [30d: OR: 0.57; 95% CI 0.44 to 0.75; P<0.001; 90d: OR: 0.71; 95% CI 0.60 to 0.84; P<0.001], and positive surgical margin [PSM OR: 0.65; 95% CI 0.49 to 0.85; P=0.002]. However, iRARC had a longer operative time [OT WMD: 68.54; 95%CI 47.41 to 89.67; P<0.001] and a higher rate of ureteroenteric stricture [ UES OR: 1.56; 95% CI 1.16 to 2.11; P=0.003]. Time to flatus, time to bowel, time to regular diet, readmission rate, Clavien-Dindo grades CONCLUSION Robot-assisted laparoscopic cystectomy with intracorporeal urinary diversion appears to be superior to open radical cystectomy in terms of effectiveness and safety. However, attention should be paid to the occurrence of ureteroenteric stricture during follow-up.
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Affiliation(s)
- Shi Fu
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - HongJin Shi
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhinan Fan
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
- Department of Urology, Meishan People's Hospital, Meishan, China
| | - Jinze Li
- Department of Urology/Institute of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Ting Luan
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Haonan Dong
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jincheng Wang
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shuwen Chen
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jinsong Zhang
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jiansong Wang
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Mingxia Ding
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Haifeng Wang
- Department of Urology, the Second Affiliated Hospital of Kunming Medical University, Kunming, China
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Sasaki Y, Daizumoto K, Fukuta K, Shiozaki K, Nishiyama M, Utsunomiya S, Kobayashi S, Seto K, Ueno Y, Tomida R, Kusuhara Y, Fukawa T, Nakanishi R, Yamaguchi K, Yamamoto Y, Izaki H, Takahashi M. Lymph node dissection during radical cystectomy for bladder cancer: A two-center comparative study of robotic versus open surgery. Asian J Endosc Surg 2023; 16:724-730. [PMID: 37489628 DOI: 10.1111/ases.13234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 07/12/2023] [Indexed: 07/26/2023]
Abstract
INTRODUCTION This study was performed to evaluate the safety and efficacy of lymph node dissection (LND) during robot-assisted radical cystectomy (RARC) compared with open radical cystectomy (ORC). METHODS From October 2003 to December 2021, 122 patients underwent LND during RARC and 103 patients underwent LND during ORC at Tokushima University Hospital and Tokushima Prefectural Central Hospital. We investigated the safety and efficacy of LND during RARC by comparing the surgical and oncological outcomes between the two groups. RESULTS The patients were significantly older in the RARC than the ORC group. The operative time was significantly shorter and the estimated blood loss was significantly lower in the RARC than the ORC group. Although the lymph node yield was significantly higher in the RARC than the ORC group, there was no significant difference in lymph node positivity between the groups. There was no significant difference in the incidence of local recurrence or distant metastasis between the two groups. The 5-year survival rates (overall survival, cancer-specific survival, and recurrence-free survival) were not different between the RARC and ORC groups. CONCLUSION This study suggests that the surgical and oncological safety and efficacy of LND during RARC are greater than those of LND during ORC. We believe that LND during RARC is a higher-quality procedure than LND during ORC.
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Affiliation(s)
- Yutaro Sasaki
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kei Daizumoto
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kyotaro Fukuta
- Department of Urology, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Keito Shiozaki
- Department of Urology, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Mitsuki Nishiyama
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Seiya Utsunomiya
- Department of Urology, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Saki Kobayashi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Kosuke Seto
- Department of Urology, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Yoshiteru Ueno
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Ryotaro Tomida
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yoshito Kusuhara
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Tomoya Fukawa
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Ryoichi Nakanishi
- Department of Urology, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Kunihisa Yamaguchi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Yasuyo Yamamoto
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
| | - Hirofumi Izaki
- Department of Urology, Tokushima Prefectural Central Hospital, Tokushima, Japan
| | - Masayuki Takahashi
- Department of Urology, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan
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Li P, Meng C, Peng L, Gan L, Xie Y, Liu Y, Li Y. Perioperative comparison between robot-assisted and laparoscopic radical cystectomy: An update meta-analysis. Asian J Surg 2023; 46:3464-3479. [PMID: 37188592 DOI: 10.1016/j.asjsur.2023.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 01/01/2023] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
We conducted this study to explore the efficacy and safety of laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) for bladder cancer (BC).We searched the PubMed, Embase, Cochrane Library and Web of Science databases for studies on LRC and RARC treatment of BC from the time of the databases creation to May 1, 2022. We extracted data and used Stata 16.0 for calculation and statistical analyses.Thirteen studies with 1509 patients were included. Meta-analysis showed no statistically significant differences (P > 0.05) between RARC and LRC in terms of operative time (weighted mean difference [WMD] = 14.48; 95% confidence interval [CI][-2.49, 31.44], P = 0.001), estimated intraoperative blood loss (WMD = -4.23; 95% CI [-81.48, 73.01], P = 0.001), intraoperative blood transfusion (odds ratio [OR] = 0.7; 95% CI [0.39, 1.27]; P = 0.011), positive surgical margins (OR = 1.21; 95% CI [0.61, 2.03]; P = 0.855), time to regular diet, length of hospital stay (WMD = 0.37, 95% CI [-1.73, 2.46]; P = 0.001), postoperative hospital days (WMD = -0.52; 95% CI [-1.15, 0.11], P = 0.359), intraoperative complications, 30- day postoperative complications, and 90- day postoperative complications. However the RARC lymph node yield was higher than that of LRC (WMD = 1.87; 95% CI [0.74, 2.99], P = 0.147).Our study showed that LRC and RARC have similar efficacy and safety profiles for the treatment of muscle invasive bladder cancer.
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Affiliation(s)
- Pan Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China; Department of Urology, The People's Hospital of Pengan County, Pengan, 637800, Nanchong, Sichuan, China
| | - Chunyang Meng
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China
| | - Lei Peng
- Department of Urology, The Second Hospital of Lanzhou University Medical School, Lanzhou, Gansu, 730000, China
| | - Lijian Gan
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China
| | - Ye Xie
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China
| | - Yi Liu
- Department of Urology, The People's Hospital of Pengan County, Pengan, 637800, Nanchong, Sichuan, China
| | - Yunxiang Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 637000, Sichuan, China.
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Yamamoto Y, Kawashima A, Morishima T, Uemura T, Yamamoto A, Yamamichi G, Tomiyama E, Matsushita M, Kato T, Hatano K, Miyashiro I, Nonomura N. Comparative Effectiveness of Radiation Versus Radical Cystectomy for Localized Muscle-Invasive Bladder Cancer. Adv Radiat Oncol 2023; 8:101157. [PMID: 36896218 PMCID: PMC9991535 DOI: 10.1016/j.adro.2022.101157] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 12/19/2022] [Indexed: 12/28/2022] Open
Abstract
Purpose Radical cystectomy (RC) with neoadjuvant chemotherapy is the most commonly recommended treatment for muscle-invasive bladder cancer (MIBC), yet RC with urinary diversion remains an invasive treatment. Although some patients with MIBC gain good cancer control with radiation therapy (RT), its effectiveness remains under discussion. Therefore, we aimed to reveal the effectiveness of RT compared with RC for MIBC. Methods and Materials Using cancer registry and administrative data from 31 hospitals in our prefecture, we recruited patients with bladder cancer (BC) initially registered between January 2013 and December 2015. All patients received RC or RT, and none had metastases. Prognostic factors for overall survival (OS) were analyzed by Cox proportional hazards model and log-rank test. Propensity score matching between the RC and RT groups was performed to examine the association of each factor with OS. Results Among the patients with BC, 241 received RC and 92 received RT. Median ages of the patients receiving RC and RT were 71.0 and 76.5 years, respectively. Five-year OS rates were 44.8% for patients receiving RC and 27.6% for patients receiving RT (P < .001). Multivariate analysis for OS showed that older age, poorer functional disability, clinical node positive, and pathology of nonurothelial carcinoma were significantly associated with worse prognosis. A propensity score-matching model identified 77 patients with RC and 77 with RT. In this arranged cohort, there were no significant differences in OS between the RC and RT groups (P = .982). Conclusions Prognostic analysis with matched characteristics showed that patients with BC receiving RT were not significantly different from those receiving RC. These findings could contribute to proper treatment strategies for MIBC.
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Affiliation(s)
- Yoshiyuki Yamamoto
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan.,Department of Urology, Osaka International Cancer Institute, Osaka, Japan
| | - Atsunari Kawashima
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | | | - Toshihiro Uemura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akinaru Yamamoto
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Gaku Yamamichi
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Eisuke Tomiyama
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Makoto Matsushita
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Taigo Kato
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Koji Hatano
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
| | - Isao Miyashiro
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Norio Nonomura
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan
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8
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Zhong W, Li J, Liu L, Hong P, Cheng S, Xia K, He W, Hao H, Ma L, Li X, Zhou L, Lin T, Huang J. Comparison of minimally invasive versus open pelvic organ-preserving radical cystectomy in female patients with bladder cancer: a multicenter propensity score matching analysis. World J Urol 2023; 41:501-508. [PMID: 36581769 DOI: 10.1007/s00345-022-04232-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 11/22/2022] [Indexed: 12/31/2022] Open
Abstract
PURPOSE To compare the perioperative and oncologic outcomes between minimally invasive pelvic organ-preserving radical cystectomy (MIPOPRC) and open pelvic organ-preserving radical cystectomy (open POPRC) among female patients with bladder cancer (BCa). METHODS We identified female patients who underwent POPRC for BCa at three centers between January 2006 and April 2018. Female patients who underwent open POPRC were matched with those who underwent MIPOPRC using 1:1 propensity score (PS) matching. The patient demographics and perioperative and oncologic outcomes were evaluated for the comparison between MIPOPRC and open POPRC. RESULTS Among the 158 patients enrolled, 83 patients underwent MIPOPRC, and 75 underwent open POPRC. A total of 60 MIPOPRC and 60 open POPRC patients were matched successfully. The cancer-specific survival (CSS) and recurrence-free survival (RFS) did not differ significantly in the propensity score-weighted cohort (p = 0.297 and p = 0.600, respectively). Subgroup analysis by age and pathologic stage in the matched cohort revealed that CSS and RFS were with no differences among all subgroups. Moreover, multivariable Cox regression analyses showed that the surgical approach (MIPOPRC vs open POPRC) was not a predictor of CSS (p = 0.250). CONCLUSION MIPOPRC was non-inferior to open POPRC in terms of oncologic outcomes among female patients. MIPOPRC could be technically feasible in selected female patients with BCa.
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Affiliation(s)
- Wenlong Zhong
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, People's Republic of China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Jibiao Li
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, People's Republic of China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Libo Liu
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, People's Republic of China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Peng Hong
- Department of Urology, Peking University Third Hospital, Beijing, People's Republic of China
| | - Sida Cheng
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, 100034, People's Republic of China
| | - Kun Xia
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, People's Republic of China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Wang He
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, People's Republic of China
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China
| | - Han Hao
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, 100034, People's Republic of China
| | - Lulin Ma
- Department of Urology, Peking University Third Hospital, Beijing, People's Republic of China
| | - Xuesong Li
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, 100034, People's Republic of China.
| | - Liqun Zhou
- Department of Urology, Peking University First Hospital, Institute of Urology, Peking University, National Urological Cancer Center, Beijing, 100034, People's Republic of China.
| | - Tianxin Lin
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, People's Republic of China.
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China.
| | - Jian Huang
- Department of Urology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, People's Republic of China.
- Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, People's Republic of China.
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9
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Hoeh B, Flammia RS, Hohenhorst L, Sorce G, Chierigo F, Panunzio A, Tian Z, Saad F, Gallucci M, Briganti A, Terrone C, Shariat SF, Graefen M, Tilki D, Antonelli A, Kluth LA, Becker A, Chun FKH, Karakiewicz PI. Outcomes of robotic-assisted versus open radical cystectomy in a large-scale, contemporary cohort of bladder cancer patients. J Surg Oncol 2022; 126:830-837. [PMID: 35661361 DOI: 10.1002/jso.26973] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/30/2022] [Accepted: 05/18/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND OBJECTIVES To test for differences in perioperative outcomes and total hospital costs (THC) in nonmetastatic bladder cancer patients undergoing open (ORC) versus robotic-assisted radical cystectomy (RARC). METHODS We relied on the National Inpatient Sample database (2016-2019). Statistics consisted of trend analyses, multivariable logistic, Poisson, and linear regression models. RESULTS Of 5280 patients, 1876 (36%) versus 3200 (60%) underwent RARC versus ORC. RARC increased from 32% to 41% (estimated annual percentage change [EAPC]: + 8.6%; p = 0.02). Rates of transfusion (8% vs. 16%), intraoperative (2% vs. 3%), wound (6% vs. 10%), and pulmonary (6% vs. 10%) complications were lower in RARC patients (all p < 0.05). Moreover, median length of stay (LOS) was shorter in RARC (6 vs. 7days; p < 0.001). Conversely, median THC (31,486 vs. 27,162$; p < 0.001) were higher in RARC. Multivariable logistic regression-derived odds ratios addressing transfusion (0.49), intraoperative (0.53), wound (0.68), and pulmonary (0.71) complications favored RARC (all p < 0.01). In multivariable Poisson and linear regression models, RARC was associated with shorter LOS (Rate ratio:0.86; p < 0.001), yet higher THC (Coef.:5,859$; p < 0.001). RARC in-hospital mortality was lower (1% vs. 2%; p = 0.04). CONCLUSIONS RARC complications, LOS, and mortality appear more favorable than ORC, but result in higher THC. The favorable RARC profile contributes to its increasing popularity throughout the United States.
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Affiliation(s)
- Benedikt Hoeh
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany.,Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Rocco S Flammia
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.,Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Lukas Hohenhorst
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.,Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriele Sorce
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.,Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Chierigo
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.,Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Andrea Panunzio
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada.,Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
| | - Michele Gallucci
- Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I Hospital, Rome, Italy
| | - Alberto Briganti
- Division of Experimental Oncology/Unit of Urology, URI, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Carlo Terrone
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.,Department of Urology, Weill Cornell Medical College, New York, New York, USA.,Department of Urology, University of Texas Southwestern, Dallas, Texas, USA.,Department of Urology, Second Faculty of Medicine, Charles University, Prague, Czech Republic.,Institute for Urology and Reproductive Health, I.M. Sechenov First Moscow State Medical University, Moscow, Russia.,Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Markus Graefen
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Derya Tilki
- Martini-Klinik Prostate Cancer Center, University Hospital Hamburg-Eppendorf, Hamburg, Germany.,Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany.,Department of Urology, Koc University Hospital, Istanbul, Turkey
| | - Alessandro Antonelli
- Department of Urology, University of Verona, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Luis A Kluth
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Andreas Becker
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Felix K H Chun
- Department of Urology, University Hospital Frankfurt, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, Division of Urology, University of Montréal Health Center, Montréal, Québec, Canada
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10
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Busetto GM, D’Agostino D, Colicchia M, Palmer K, Artibani W, Antonelli A, Bianchi L, Bocciardi A, Brunocilla E, Carini M, Carrieri G, Cormio L, Falagario UG, De Berardinis E, Sciarra A, Leonardo C, Del Giudice F, Maggi M, de Cobelli O, Ferro M, Musi G, Ercolino A, Di Maida F, Gallina A, Introini C, Mearini E, Cochetti G, Minervini A, Montorsi F, Schiavina R, Serni S, Simeone C, Parma P, Serao A, Mangano MS, Pomara G, Ditonno P, Simonato A, Romagnoli D, Crestani A, Porreca A. Robot-Assisted, Laparoscopic, and Open Radical Cystectomy: Pre-Operative Data of 1400 Patients From The Italian Radical Cystectomy Registry. Front Oncol 2022; 12:895460. [PMID: 35600337 PMCID: PMC9117739 DOI: 10.3389/fonc.2022.895460] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/06/2022] [Indexed: 12/16/2022] Open
Abstract
Introduction The Italian Radical Cystectomy Registry (RIC) is an observational prospective study aiming to understand clinical variables and patient characteristics associated with short- and long-term outcomes among bladder cancer (BC) patients undergoing radical cystectomy (RC). Moreover, it compares the effectiveness of three RC techniques - open, robotic, and laparoscopic. Methods From 2017 to 2020, 1400 patients were enrolled at one of the 28 centers across Italy. Patient characteristics, as well as preoperative, postoperative, and follow-up (3, 6, 12, and 24 months) clinical variables and outcomes were collected. Results Preoperatively, it was found that patients undergoing robotic procedures were younger (p<.001) and more likely to have undergone preoperative neoadjuvant chemotherapy (p<.001) and BCG instillation (p<.001). Hypertension was the most common comorbidity among all patients (55%), and overall, patients undergoing open and laparoscopic RC had a higher Charlson Comorbidities Index (CCI) compared to robotic RC (p<.001). Finally, laparoscopic patients had a lower G-stage classification (p=.003) and open patients had a higher ASA score (p<.001). Conclusion The present study summarizes the characteristic of patients included in the RIC. Future results will provide invaluable information about outcomes among BC patients undergoing RC. This will inform physicians about the best techniques and course of care based on patient clinical factors and characteristics.
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Affiliation(s)
- Gian Maria Busetto
- Department of Urology and Renal Transplantation, University of Foggia, Policlinico Riuniti, Foggia, Italy
- *Correspondence: Gian Maria Busetto,
| | | | | | - Katie Palmer
- Department of Internal Medicine and Geriatrics, University Cattolica del Sacro Cuore, Rome, Italy
| | - Walter Artibani
- Department of Urology, Policlinico Abano Terme, Abano Terme, Italy
| | - Alessandro Antonelli
- Department of Urology, Azienda Ospedaliera Universitaria Integrata (A.O.U.I.), Verona, Italy
| | - Lorenzo Bianchi
- Department of Urology, University of Bologna, Bologna, Italy
| | | | | | - Marco Carini
- Department of Urology, University of Florence, Florence, Italy
| | | | - Luigi Cormio
- Department of Urology, Villa Salus Clinic, Mestre, Italy
| | | | - Ettore De Berardinis
- Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Alessandro Sciarra
- Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Costantino Leonardo
- Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Francesco Del Giudice
- Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Martina Maggi
- Department of Maternal-Child and Urological Sciences, Sapienza Rome University, Policlinico Umberto I, Rome, Italy
| | - Ottavio de Cobelli
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Matteo Ferro
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
| | - Amelio Ercolino
- Department of Urology, University of Bologna, Bologna, Italy
| | | | - Andrea Gallina
- Department of Urology, San Raffaele Hospital and Scientific Institute, Milan, Italy
| | | | - Ettore Mearini
- Department of Urology, University of Perugia, Perugia, Italy
| | | | | | - Francesco Montorsi
- Department of Urology, San Raffaele Hospital and Scientific Institute, Milan, Italy
| | | | - Sergio Serni
- Department of Urology, University of Florence, Florence, Italy
| | - Claudio Simeone
- Department of Urology, University of Brescia, Brescia, Italy
| | - Paolo Parma
- Department of Urology, Azienda Socio Sanitaria Territoriale (ASST) Mantova, Mantova, Italy
| | - Armando Serao
- Department of Urology, Azienda Ospedaliera di Alessandria, Alessandria, Italy
| | | | - Giorgio Pomara
- Department of Urology, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Pasquale Ditonno
- Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy
| | - Alchiede Simonato
- Department of Surgical, Oncological and Oral Sciences, Section of Urology, University of Palermo, Palermo, Italy
| | | | - Alessandro Crestani
- Oncological Urology, Veneto Institute of Oncology (IOV) – Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
| | - Angelo Porreca
- Oncological Urology, Veneto Institute of Oncology (IOV) – Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padua, Italy
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11
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Basourakos SP, Al Hussein Al Awamlh B, Borregales LD, Abrahimi P, Sedrakyan A, Shoag JE, Hu JC. A comparative population-based analysis of peritoneal carcinomatosis in patients undergoing robotic-assisted and open radical cystectomy. Int Urol Nephrol 2022; 54:1513-1519. [PMID: 35476175 DOI: 10.1007/s11255-022-03216-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/05/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE To compare the population-based incidence of peritoneal carcinomatosis following open (ORC) vs. robotic-assisted radical cystectomy (RARC). METHODS Using the Surveillance, Epidemiology and End Results Program (SEER)-Medicare linked data, we identified 1,621 patients who underwent radical cystectomy for bladder cancer during 2009 and 2014; 18.1% (n = 294) and 81.9% (n = 1327) underwent RARC and ORC, respectively. We subsequently evaluated the rates of peritoneal carcinomatosis at 6, 12, and 24 months following surgery. Multivariable proportional hazards regression was performed to determine factors associated with development of peritoneal carcinomatosis. RESULTS Patients who underwent RARC vs. ORC were more likely to be male (p = 0.04); however, age at diagnosis, race, comorbidities, education, and marital status (all p > 0.05) did not differ by surgical approaches. Our findings showed that there were no significant differences in the rates of peritoneal carcinomatosis between ORC and RARC at 6, 12, and 24 months. In adjusted analyses, factors associated with peritoneal carcinomatosis were advanced N stage (N0 versus N2/3: HR 0.30, 95% CI 0.16-0.55, p < 0.01), preoperative hydronephrosis (HR 1.70, 95% CI 1.09-2.65, p = 0.04), higher T stage (T1 versus T4: HR 0.34, 95% CI 0.15-0.79, p < 0.01; T2 versus T4: HR 0.39, 95% CI 0.20-0.76, p < 0.01), and use of neoadjuvant chemotherapy (HR 1.78, 95% CI 1.11-2.84, p < 0.01). However, RARC was not associated with peritoneal carcinomatosis (HR 1.36, 95% CI 0.78-2.35). CONCLUSION In this population-based analysis, we found no difference in peritoneal carcinomatosis between robotic or open approaches to radical cystectomy. These data should be reassuring to those utilizing robotic cystectomy.
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Affiliation(s)
- Spyridon P Basourakos
- Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Starr 900, New York, NY, 10021, USA
| | - Bashir Al Hussein Al Awamlh
- Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Starr 900, New York, NY, 10021, USA
| | - Leonardo D Borregales
- Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Starr 900, New York, NY, 10021, USA
| | - Parwiz Abrahimi
- Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Starr 900, New York, NY, 10021, USA
| | - Art Sedrakyan
- Department of Health Policy, Weill Cornell Medicine, New York, NY, USA
| | - Jonathan E Shoag
- Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Starr 900, New York, NY, 10021, USA.,Department of Urology, Case Western Reserve University School of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Jim C Hu
- Department of Urology, NewYork-Presbyterian Hospital, Weill Cornell Medicine, 525 East 68th Street, Starr 900, New York, NY, 10021, USA.
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12
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Elshabrawy A, Wang H, Dursun F, Kaushik D, Liss M, Svatek RS, Mansour AM. Diffusion of robot-assisted radical cystectomy: Nationwide trends, predictors, and association with continent urinary diversion. Arab J Urol 2022; 20:159-167. [PMID: 35935907 PMCID: PMC9354633 DOI: 10.1080/2090598x.2022.2032562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Affiliation(s)
- Ahmed Elshabrawy
- Department of Urology, University of Texas (UT) Health, San Antonio, TX, USA
| | - Hanzhang Wang
- Department of Urology, University of Texas (UT) Health, San Antonio, TX, USA
| | - Furkan Dursun
- Department of Urology, University of Texas (UT) Health, San Antonio, TX, USA
| | - Dharam Kaushik
- Department of Urology, University of Texas (UT) Health, San Antonio, TX, USA
- UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX, USA
| | - Michael Liss
- Department of Urology, University of Texas (UT) Health, San Antonio, TX, USA
- UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX, USA
| | - Robert S. Svatek
- Department of Urology, University of Texas (UT) Health, San Antonio, TX, USA
- UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX, USA
| | - Ahmed M. Mansour
- Department of Urology, University of Texas (UT) Health, San Antonio, TX, USA
- UT Health San Antonio/MD Anderson Mays Cancer Center, San Antonio, TX, USA
- Urology and Nephrology Center, Mansoura University, Mansoura, Egypt
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13
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Abaza R, Kogan P, Martinez O. Narcotic Avoidance After Robotic Radical Cystectomy Allows Routine of Only Two-Day Hospital Stay. Urology 2021; 161:65-70. [PMID: 34968571 DOI: 10.1016/j.urology.2021.10.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 10/22/2021] [Accepted: 10/31/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the outcomes of a narcotic-sparing clinical pathway after robotic-assisted radical cystectomy (RARC) with ileal conduit targeting discharge on postoperative day #2 and report postoperative narcotic consumption, pain scores, and the resulting length of stay (LOS). METHODS We reviewed a single-surgeon series of consecutive RARCs between August 2015-September 2020. Acetaminophen and ketorolac were given with thorough patient education reserving oral narcotics for breakthrough pain. Intravenous narcotics were intentionally excluded from postoperative orders. Alvimopan was given once it became available. Subcutaneous ropivacaine pain pumps were removed before discharge. Discharge criteria included diet, oral analgesia, ambulation, and bowel function. Narcotic use and pain scores were evaluated to deternine the success of the applied narcotic-avoidance strategy. RESULTS None of the 54 patients required intravenous narcotics postoperatively, and 19 patients (35%) never required even oral narcotics. Mean pain scores were higher in patients who required oral narcotics (4.3/11 vs 3.0/11, p=0.001, respectively). Among 35 patients who received narcotics, mean tablets taken were 4.3/day (range, 1-13) with 68% using 8 or less tablets during their entire LOS. Mean LOS was 2.1d (range 1-4). Five patients (9%) were discharged on POD#1, 37/54 (68.5%) on POD #2, 10/54 (18.5%) on POD#3 and 2/54 (4%) on POD #4. Eight patients (15%) were readmitted within 90 days. CONCLUSION Minimizing narcotics after RARC with conduit allowed for a 2-day LOS in the majority of patients and the shortest ever reported mean LOS after cystectomy, essentially halving hospitalization time. Patient education is critical to minimizing narcotic usage.
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Affiliation(s)
- Ronney Abaza
- Central Ohio Urology Group, LLC, Columbus, Ohio, USA.
| | - Paul Kogan
- Robotic Surgery, OhioHealth Dublin Methodist Hospital, Dublin, Ohio, USA
| | - Oscar Martinez
- Robotic Surgery, OhioHealth Dublin Methodist Hospital, Dublin, Ohio, USA
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14
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Zhou N, Tian F, Feng Y, Zhao K, Chen L, Fan R, Lu W, Gu C. Perioperative outcomes of intracorporeal robot-assisted radical cystectomy versus open radical cystectomy: A systematic review and meta-analysis of comparative studies. Int J Surg 2021; 94:106137. [PMID: 34600124 DOI: 10.1016/j.ijsu.2021.106137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 08/20/2021] [Accepted: 09/28/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To systematically review studies comparing the perioperative outcomes of intracorporeal robot-assisted radical cystectomy (iRARC) and open radical cystectomy (ORC). METHODS Systematic searches of PubMed, Web of Science and the Cochrane Library were performed in June 2020. Studies with data comparing iRARC and ORC were included in our review, and a pooled meta-analysis was completed. RESULTS In total, 8 studies (7 prospective studies, 1 retrospective study) comparing 1193 patients were included for our review and meta-analysis. Compared with ORC, iRARC demonstrated lower estimated blood loss (weighted mean difference (WMD): -449.25; 95% CI -566.47 - -332.03; p < 0.01), lower blood transfusion rates (OR: 0.31; 95% CI 0.22 - 0.46; p < 0.01), and lower postoperative complication rates with Clavien-Dindo grades III-IV (30 days: OR: 0.65; 95% CI 0.47 - 0.90; p = 0.01; 90 days: OR: 0.72; 95% CI 0.53 - 0.98; p = 0.04), but a longer operative time (WMD: 78.82; 95% CI 52.77 - 104.87; P < 0.01). Furthermore, there was no significant difference between iRARC and ORC in terms of postoperative complication rates with Clavien-Dindo grades Ⅰ-Ⅱ (30 days: OR: 0.71; 95% CI 0.36 - 1.40; p = 0.32; 90 days: OR: 0.98; 95% CI 0.74 - 1.30; p = 0.89), length of stay (WMD: -1.18; 95% CI -3.33 - -2.07; p = 0.06) and positive surgical margins (OR: 0.78; 95% CI 0.0.45 - 1.36; p = 0.38). CONCLUSION iRARC was associated with a significantly lower estimated blood loss and a lower blood transfusion rate and major postoperative complication rate than ORC.
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Affiliation(s)
- Naichun Zhou
- Department of Urology, Xinyang Central Hospital, Xinyang, 464000, China Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China Department of Pediatrics, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
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15
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Yu A, Wang Y, Mossanen M, Preston M, Carvalho FL, Chung BI, Chang SL. Robotic-assisted radical cystectomy is associated with lower perioperative mortality in octogenarians. Urol Oncol 2021; 40:163.e19-163.e23. [PMID: 34602361 DOI: 10.1016/j.urolonc.2021.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 08/17/2021] [Accepted: 08/30/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To compare perioperative outcomes between robotic and open radical cystectomy in octogenarians using real-world data SUBJECTS AND METHODS: Using the Premier Healthcare Database, we found 13,127 patients who underwent robotic-assisted radical cystectomy (RARC) between 2008 and 2017, of which 15.1% were ≥80 years old. Perioperative mortality was the primary outcome of interest. Secondary outcomes include complications, hospital length of stay, readmission rates, and disposition after discharge. Multivariable regression analysis was used to adjust for patient and hospital characteristics. RESULTS In octogenarians, mortality at the index admission was 2.2% in those who underwent RARC, compared to 4.6% in those who underwent open surgery (P = 0.027). On multivariable analysis, robotic surgery was associated with lower in-hospital mortality in octogenarians (OR 0.46, 95% CI 0.22-0.99, P = 0.047) even after controlling for patient, and hospital characteristics. CONCLUSION RARC is safe and feasible in octogenarians. Elderly patients may derive more benefit from minimally invasive radical cystectomy compared to a younger cohort.
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Affiliation(s)
- Alice Yu
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, Tampa, FL; Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA.
| | - Ye Wang
- Center for Surgery and Public Health, Brigham, and Women's Hospital, Boston, MA
| | - Matthew Mossanen
- Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA
| | - Mark Preston
- Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA
| | | | - Benjamin I Chung
- Department of Urology, Stanford University Medical Center, Stanford, CA
| | - Steven L Chang
- Division of Urologic Surgery, Brigham and Women's Hospital, Boston, MA
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16
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Hinsenveld FJ, Boormans JL, van der Poel HG, van der Schoot DKE, Vis AN, Aben KKH, Arends TJ, Ausems PJ, Baselmans D, Berger C, Berrens A, Bickerstaffe H, Bos SD, Braam M, Buddingh KT, Claus S, Dekker K, van Doeveren T, Einerhand S, Fossion L, van Gennep EJ, van Ginkel N, Palacios LAG, Hermans T, Hobijn MM, van Huystee SH, Jaspers-Valentijn M, Klaver OS, Koldewijn EL, Korsten L, Lenting A, Lentjes KJ, Luiting HB, van der Meer S, Nieuwenhuijzen JA, Noordzij MA, Nooter RI, Notenboom C, Oomen R, van Roermund J, de Rooij J, Roshani H, Schrier BP, van der Slot MA, Somford DM, Stelwagen PJ, Stroux A, van der West A, Wijsman BP, Windt W, van Zanten P, van Beek SC. Intermediate-term survival of robot-assisted versus open radical cystectomy for muscle-invasive and high-risk non-muscle invasive bladder cancer in The Netherlands. Urol Oncol 2021; 40:60.e1-60.e9. [PMID: 34303597 DOI: 10.1016/j.urolonc.2021.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/31/2021] [Accepted: 06/21/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Radical cystectomy with pelvic lymph node dissection is the recommended treatment in non-metastatic muscle-invasive bladder cancer (MIBC). In randomised trials, robot-assisted radical cystectomy (RARC) showed non-inferior short-term oncological outcomes compared with open radical cystectomy (ORC). Data on intermediate and long-term oncological outcomes of RARC are limited. OBJECTIVE To assess the intermediate-term overall survival (OS) and recurrence-free survival (RFS) of patients with MIBC and high-risk non-MIBC (NMIBC) who underwent ORC versus RARC in clinical practice. METHODS AND MATERIALS A nationwide retrospective study in 19 Dutch hospitals including patients with MIBC and high-risk NMIBC treated by ORC (n = 1086) or RARC (n = 386) between January 1, 2012 and December 31, 2015. Primary and secondary outcome measures were median OS and RFS, respectively. Survival outcomes were estimated using Kaplan-Meier curves. A multivariable Cox regression model was developed to adjust for possible confounders and to assess prognostic factors for survival including clinical variables, clinical and pathological disease stage, neoadjuvant therapy and surgical margin status. RESULTS The median follow-up was 5.1 years (95% confidence interval ([95%CI] 5.0-5.2). The median OS after ORC was 5.0 years (95%CI 4.3-5.6) versus 5.8 years after RARC (95%CI 5.1-6.5). The median RFS was 3.8 years (95%CI 3.1-4.5) after ORC versus 5.0 years after RARC (95%CI 3.9-6.0). After multivariable adjustment, the hazard ratio for OS was 1.00 (95%CI 0.84-1.20) and for RFS 1.08 (95%CI 0.91-1.27) of ORC versus RARC. Patients who underwent ORC were older, had higher preoperative serum creatinine levels and more advanced clinical and pathological disease stage. CONCLUSION ORC and RARC resulted in similar intermediate-term OS and RFS in a cohort of almost 1500 MIBC and high-risk NMIBC.
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Affiliation(s)
- Florentien J Hinsenveld
- Department of Urology, Amsterdam University Medical Centres location Vrije University Medical Centre, Amsterdam, The Netherlands
| | - Joost L Boormans
- Department of Urology, Erasmus Medical Centre, Rotterdam, The Netherlands.
| | - Henk G van der Poel
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | | | - André N Vis
- Department of Urology, Amsterdam University Medical Centres location Vrije University Medical Centre, Amsterdam, The Netherlands
| | - Katja K H Aben
- Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands; Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - T J Arends
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - P J Ausems
- Department of Urology, HagaZiekenuis, Den Haag, The Netherlands
| | - D Baselmans
- Department of Urology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - Cpam Berger
- Department of Urology, Haaglanden Medical Centre, Den Haag, The Netherlands
| | - A Berrens
- Department of Urology, Franciscus Hospital, Rotterdam, The Netherlands
| | - H Bickerstaffe
- Department of Urology, Bravis Hospital, Bergen op Zoom, Roosendaal, The Netherlands
| | - S D Bos
- Department of Urology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - M Braam
- Department of Urology, Martini Hospital, Groningen, The Netherlands
| | - K T Buddingh
- Department of Urology, HagaZiekenuis, Den Haag, The Netherlands
| | - S Claus
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
| | - K Dekker
- Department of Urology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - T van Doeveren
- Department of Urology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Smh Einerhand
- Department of Urology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Lmcl Fossion
- Department of Urology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - E J van Gennep
- Department of Urology, Leiden University Medical Centre, Leiden, The Netherlands
| | - N van Ginkel
- Department of Urology, Spaarne Gasthuis, Haarlem, Hoofddorp, The Netherlands
| | | | - Tjn Hermans
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - M M Hobijn
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - S H van Huystee
- Department of Urology, Noordwest Ziekenhuisgroep, Alkmaar, The Netherlands
| | - M Jaspers-Valentijn
- Department of Urology, Bravis Hospital, Bergen op Zoom, Roosendaal, The Netherlands
| | - O S Klaver
- Department of Urology, Maasstad Hospital, Rotterdam, The Netherlands
| | - E L Koldewijn
- Department of Urology, Catharina Hospital, Eindhoven, The Netherlands
| | - L Korsten
- Department of Urology, Elisabeth TweeSteden Hospital, Tilburg, The Netherland
| | - A Lenting
- Department of Urology, Franciscus Hospital, Rotterdam, The Netherlands
| | - K J Lentjes
- Department of Urology, Leiden University Medical Centre, Leiden, The Netherlands
| | - H B Luiting
- Department of Urology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - S van der Meer
- Department of Urology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - J A Nieuwenhuijzen
- Department of Urology, Amsterdam University Medical Centres location Vrije University Medical Centre, Amsterdam, The Netherlands
| | - M A Noordzij
- Department of Urology, Spaarne Gasthuis, Haarlem, Hoofddorp, The Netherlands
| | - R I Nooter
- Department of Urology, Franciscus Hospital, Rotterdam, The Netherlands
| | - Caw Notenboom
- Department of Urology, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Rja Oomen
- Department of Urology, Elisabeth TweeSteden Hospital, Tilburg, The Netherland
| | - Jgh van Roermund
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J de Rooij
- Department of Urology, Máxima Medical Centre, Veldhoven, The Netherlands
| | - H Roshani
- Department of Urology, HagaZiekenuis, Den Haag, The Netherlands
| | - B P Schrier
- Department of Urology, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - M A van der Slot
- Department of Urology, Maasstad Hospital, Rotterdam, The Netherlands
| | - D M Somford
- Department of Urology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - P J Stelwagen
- Department of Urology, Amsterdam University Medical Centres location Vrije University Medical Centre, Amsterdam, The Netherlands
| | - Ama Stroux
- Department of Urology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A van der West
- Department of Urology, Spaarne Gasthuis, Haarlem, Hoofddorp, The Netherlands
| | - B P Wijsman
- Department of Urology, Elisabeth TweeSteden Hospital, Tilburg, The Netherland
| | - Wakm Windt
- Department of Urology, Martini Hospital, Groningen, The Netherlands
| | - P van Zanten
- Department of Urology, HagaZiekenuis, Den Haag, The Netherlands
| | - Sytse C van Beek
- Department of Urology, Erasmus Medical Centre, Rotterdam, The Netherlands
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17
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Kukreja JB, Li R, Narayan VM, Lim A, Seif M, Wang X, Kamat A, Dinney C, Navai N. Oncologic Equipoise Between Robotic and Open Radical Cystectomy. J Endourol 2021; 35:1168-1176. [PMID: 33619985 DOI: 10.1089/end.2020.0450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Our objective was to establish the incidence of positive surgical margins, recurrence patterns, and recurrence-free (RFS) and overall survival (OS) in a large cohort of patients undergoing robotic (robot-assisted radical cystectomy [RARC]) and open radical cystectomy (ORC). Materials and Methods: We performed a large retrospective cohort study at a high-volume academic tertiary referral center. Patients were those who underwent RC for bladder cancer from 2005 to 2017. Patients were allocated to ORC or RARC by patient and surgeon choice. Propensity matching and a multivariable analysis were performed to determine factors predictive of RFS and OS after RC. All analyses were done with SAS 9.4. Results: The study included 1885 patients, 13.5% of whom underwent RARC. There was no difference in positive soft tissue surgical margins (2.4% in ORC and 1.2% in RARC). There were no differences in recurrence patterns, nor in the severity of pathology distribution between the two cohorts. Peritoneal carcinomatosis was seen in 1.1% of ORC and 0.8% in RARC. Shorter RFS was associated with younger age (hazard ratio [HR] 1.04, 95% confidence interval [CI] 1.03-1.05, p < 0.001), neoadjuvant chemotherapy (HR 1.41, 95% CI 1.14-1.75, p = 0.002), higher pathologic stage (stage ≥T2 HR 2.45, 95% CI 1.91-3.16, p < 0.001), lymph node positivity at cystectomy (HR 1.92, 95% CI 1.50-2.47, p < 0.001), and positive surgical margins (HR 1.49, 95% CI 1.09-2.05, p = 0.01). RFS and OS did not differ by surgical approach (HR 1.04, 95% CI 0.83-1.30), p = 0.75 and (HR 0.89, 95% CI 0.67-1.19), p = 0.43, respectively. Conclusion: The data from this study support continued use of RARC as a safe oncologic procedure, with similar outcomes to ORC.
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Affiliation(s)
- Janet Baack Kukreja
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Division of Urology, University of Colorado, Denver, Colorado, USA
| | - Roger Li
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.,Division of Urology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Vikram M Narayan
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Amy Lim
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Mohamed Seif
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Xuemei Wang
- Department of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Ashish Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Colin Dinney
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Neema Navai
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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18
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Maibom SL, Joensen UN, Poulsen AM, Kehlet H, Brasso K, Røder MA. Short-term morbidity and mortality following radical cystectomy: a systematic review. BMJ Open 2021; 11:e043266. [PMID: 33853799 PMCID: PMC8054090 DOI: 10.1136/bmjopen-2020-043266] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To study short-term (<90 days) morbidity and mortality following radical cystectomy (RC) for bladder cancer and identify modifiable risk factors associated with these. DESIGN Systematic review. METHODS The systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed and EMBASE were searched for relevant papers on 11 June 2019 and rerun on 27 May 2020. Studies reporting complications, reoperations, length of stay and mortality within 90 days were included. Studies were reviewed according to criteria from the Oxford Centre for Evidence-Based Medicine and the quality of evidence was assessed using the Newcastle-Ottawa Scale. RESULTS The search retrieved 1957 articles. Sixty-six articles were included. The quality of evidence was poor to good. Most studies were retrospective, and no randomised clinical trials were identified. Of included studies a median of 6 Martin criteria for reporting complications after surgery were fulfilled. The Clavien-Dindo classification for grading complications was most frequently used. The weighted overall complication rate after RC was 34.9% (range 28.8-68.8) for in-house complications, 39.0% (range 27.3-80.0) for 30-day complications and 58.5% (range 36.1-80.5) for 90-day complications. The most common types of complications reported were gastrointestinal (29.0%) and infectious (26.4%). The weighted mortality rate was 2.4% (range 0.9-4.7) for in-house mortality, 2.1% (0.0-3.7) for 30-day mortality and 4.7% (range 0.0-7.0) for 90-day mortality. Age and comorbidity were identified as the best predictors for complications following RC. CONCLUSION Short-term morbidity and mortality are high following RC. Reporting of complications is heterogeneous and the quality of evidence is generally low. There is a continuous need for randomised studies to address any intervention that can reduce morbidity and mortality following RC. PROSPERO REGISTRATION NUMBER 104937.
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Affiliation(s)
- Sophia Liff Maibom
- Department of Urology, Urological Research Unit, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Ulla Nordström Joensen
- Department of Urology, Urological Research Unit, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, University of Copenhagen, Copenhagen, Denmark
| | - Alicia Martin Poulsen
- Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Henrik Kehlet
- Department of Clinical Medicine, University of Copenhagen, University of Copenhagen, Copenhagen, Denmark
- Section for Surgical Pathophysiology, The Juliane Marie Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Klaus Brasso
- Department of Urology, Urological Research Unit, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Martin Andreas Røder
- Department of Urology, Urological Research Unit, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, University of Copenhagen, Copenhagen, Denmark
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19
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Tamhankar AS, Thurtle D, Hampson A, El‐Taji O, Thurairaja R, Kelly JD, Catto JWF, Lane T, Adshead J, Vasdev N. Radical Cystectomy in England from 2013 to 2019 on 12,644 patients: An analysis of national trends and comparison of surgical approaches using Hospital Episode Statistics data. BJUI COMPASS 2021; 2:338-347. [PMID: 35474875 PMCID: PMC8988840 DOI: 10.1002/bco2.79] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 02/11/2021] [Accepted: 02/12/2021] [Indexed: 01/04/2023] Open
Abstract
Introduction We evaluate the data of 12,644 Radical Cystectomies in England (Open, Robotic and Laparoscopic) with trends in the adaption of techniques and post‐operative complications. Methods This analysis utilised national Hospital Episode Statistics (HES) from NHS England. Results There was a statistically significant increase (P < .001) in the number of Robotic assisted radical cystectomies from 10.8% in 2013‐2014 and 39.5% in 2018‐2019.The average LOS reduced from 12.3 to 10.8 days for RARC from 2013 to 2019 similarly the LOS reduced from 16.2 to 14.3 for ORC. The rate of sepsis (0‐90 days) did rise from 5% to 14.5% between 2013‐2014 and 2017‐2018 for the entire cohort (P < .001). Acute renal failure (ARF) increased over the years from 9.5% to 17% (P < .001). The rate for fever, UTI, critical care activity and ARF were higher for ORC than RARC (P < .001).The comparison of all episodes within 90 days for conduit versus non‐conduit diversions showed significantly higher rates of sepsis, infections, UTI and fever in non‐conduit group .Overall complications were significantly higher in non‐conduit group throughout the duration except was year 2016‐17(P < .001).The robotic approach has increased in last 5 years with nearly 40% of the cystectomies now being robotically in 2018‐19 from the initial percentage of 10.8% in 2013‐14. Conclusion This evaluation of the HES data from NHS England for 12,644 RC confirms an increase in the adoption of Robotic Cystectomy. Our data confirms the need to develop strategies with enhanced recovery protocols and post‐operative close monitoring following Radical Cystectomy in order to reduce post‐operative complications.
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Affiliation(s)
| | - David Thurtle
- Hertfordshire and Bedfordshire Urological Cancer Centre Lister Hospital Stevenage UK
| | - Alexander Hampson
- Hertfordshire and Bedfordshire Urological Cancer Centre Lister Hospital Stevenage UK
| | - Omar El‐Taji
- Hertfordshire and Bedfordshire Urological Cancer Centre Lister Hospital Stevenage UK
| | | | - John D. Kelly
- Division of Surgery and Interventional Science University College London London UK
| | | | - Tim Lane
- Hertfordshire and Bedfordshire Urological Cancer Centre Lister Hospital Stevenage UK
| | - James Adshead
- Hertfordshire and Bedfordshire Urological Cancer Centre Lister Hospital Stevenage UK
| | - Nikhil Vasdev
- Hertfordshire and Bedfordshire Urological Cancer Centre Lister Hospital Stevenage UK
- School of Life and Medical Sciences University of Hertfordshire Hatfield UK
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20
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Faraj KS, Rose KM, Navaratnam AK, Abdul-Muhsin HM, Eversman S, Singh V, Tyson MD. Effect of intracorporeal urinary diversion on the incidence of benign ureteroenteric stricture after cystectomy. Int J Urol 2021; 28:593-597. [PMID: 33594730 DOI: 10.1111/iju.14521] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 01/12/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To compare ureteroenteric stricture rates after radical cystectomy in patients who undergo an intracorporeal urinary diversion versus other surgical approaches. METHODS We retrospectively reviewed health records of all patients who underwent cystectomy with urinary diversion at Mayo Clinic Hospital (Phoenix, AZ, USA) from 1 January 2007 through 1 January 2018. Ureteroenteric stricture was identified by surveillance imaging. Patients were stratified by surgical approach: open radical cystectomy, robot-assisted radical cystectomy with extracorporeal urinary diversion and robot-assisted radical cystectomy-intracorporeal urinary diversion. A Cox proportional hazards model was fitted that included independent predictors of stricture development. RESULTS Of the 573 cystectomies assessed, 236 (41.2%) were carried out robotically. In the robot-assisted radical cystectomy cohort, 39 patients (16.5%) underwent intracorporeal urinary diversion. The median follow-up period was 55, 70 and 71 months for the open radical cystectomy, robot-assisted radical cystectomy-extracorporeal urinary diversion and robot-assisted radical cystectomy-intracorporeal urinary diversion groups, respectively. Subgroup stricture rates were as follows: open radical cystectomy, 8.0%; robot-assisted radical cystectomy-extracorporeal urinary diversion, 9.6%; and robot-assisted radical cystectomy-intracorporeal urinary diversion, 2.6% (P = 0.33). The median time to stricture was 5 months (interquartile range 3.3-11.5 months). In the bivariable analysis, factors that were associated with the development of ureteroenteric stricture were postoperative urinary leak (hazard ratio 3.177, 95% confidence interval 1.129-8.935; P = 0.03) and body mass index (hazard ratio 1.078, 95% confidence interval 1.027-1.132; P = 0.002). On multivariable logistic regression analysis, intracorporeal urinary diversion approach was not associated with the development of ureteroenteric stricture (hazard ratio 0.272, 95% confidence interval 0.036-2.066; P = 0.21). CONCLUSIONS Ureteroenteric stricture is a complication that typically occurs within the first postoperative year. Although our results did not support major differences in outcomes between intracorporeal urinary diversion and extracorporeal urinary diversion, the small sample size did not exclude the possibility of a type 2 statistical error.
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Affiliation(s)
- Kassem S Faraj
- Department of Urology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Kyle M Rose
- Department of Urology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | | | | | - Sarah Eversman
- Department of Urology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Vijay Singh
- Department of Urology, Mayo Clinic Hospital, Phoenix, Arizona, USA
| | - Mark D Tyson
- Department of Urology, Mayo Clinic Hospital, Phoenix, Arizona, USA
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21
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Pignot G, Treacy P, Walz J. Growing evidence for benefits of minimally invasive radical cystectomy. Transl Androl Urol 2021; 9:2459-2461. [PMID: 33457215 PMCID: PMC7807372 DOI: 10.21037/tau-20-873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Geraldine Pignot
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Patrick Treacy
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Jochen Walz
- Department of Surgical Oncology, Institut Paoli-Calmettes, Marseille, France
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22
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Cai PY, Khan AI, Shoag JE, Scherr DS. Robotic Radical Cystectomy in the Contemporary Management of Bladder Cancer. Urol Clin North Am 2020; 48:45-50. [PMID: 33218593 DOI: 10.1016/j.ucl.2020.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
"The robotic approach for radical cystectomy has become increasingly adopted by the urologic oncology community, as it has been shown to have equivalent oncologic outcomes with shorter hospital stay and fewer perioperative transfusions. Consensus guidelines from expert surgeons have been published to provide guidance on all aspects of how to implement the robotic approach in the urologic oncology clinic."
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Affiliation(s)
- Peter Y Cai
- Department of Urology, New York Presbyterian - Weill Cornell Medicine, 525 East 68th Street, Starr 900, New York, NY 10065, USA
| | - Aleem I Khan
- Department of Urology, New York Presbyterian - Weill Cornell Medicine, 525 East 68th Street, Starr 900, New York, NY 10065, USA
| | - Jonathan E Shoag
- Department of Urology, New York Presbyterian - Weill Cornell Medicine, 525 East 68th Street, Starr 900, New York, NY 10065, USA
| | - Douglas S Scherr
- Department of Urology, New York Presbyterian - Weill Cornell Medicine, 525 East 68th Street, Starr 900, New York, NY 10065, USA.
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23
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Nakagawa T. Lymph node dissection for bladder cancer: Current standards and the latest evidence. Int J Urol 2020; 28:7-15. [PMID: 33145855 DOI: 10.1111/iju.14398] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 09/13/2020] [Indexed: 12/23/2022]
Abstract
Lymph node dissection is an indispensable component of radical cystectomy for bladder cancer. Information obtained with lymph node dissection is highly predictive of patient survival, affecting decision-making for adjuvant therapy (diagnostic role). Also, lymph node dissection provides survival benefits in certain patients by removing metastasized nodes (therapeutic role). However, an optimal extent of lymph node dissection has not been established yet. Data from surgical mapping studies showed that approximately 10% of the primary lymphatic landing sites were common iliac nodes, suggesting that lymph node dissection below the common iliac bifurcation is suboptimal. Several retrospective studies have shown a possible survival advantage with more extended lymph node dissection. However, the results of the first prospective randomized controlled trial failed to prove the survival advantage of extended lymph node dissection up to the level of the inferior mesenteric artery, compared with lymph node dissection below the bifurcation of the common iliac artery. Currently, lymph node dissection templates recommended by major guidelines are not consistent with each other. Furthermore, the evidence is limited in the settings of neoadjuvant chemotherapy, robot-assisted surgery and high-risk non-muscle-invasive disease. Physicians need to decide the extent of lymph node dissection for each patient, taking into account the potential survival benefit and possible harms of extended lymph node dissection. Another randomized controlled trial is currently underway and will provide further evidence shortly.
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Affiliation(s)
- Tohru Nakagawa
- Department of Urology, Teikyo University School of Medicine, Tokyo, Japan
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24
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Numao N, Fujiwara R, Uehara S, Yasuoka S, Fujiwara M, Komai Y, Yuasa T, Yamamoto S, Fukui I, Yonese J. Intraoperative Only versus Extended Duration Use of Antimicrobial Prophylaxis for Infectious Complications in Radical Cystectomy with Intestinal Urinary Diversion. Urol Int 2020; 104:954-959. [PMID: 32814326 DOI: 10.1159/000509881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 07/02/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In spite of the high incidence of infectious complications (ICs), appropriate duration of antimicrobial prophylaxis (AMP) for radical cystectomy (RC) with intestinal urinary diversion (IUD) has not been established. We compared the incidence of ICs after RC with IUD in patients using only intraoperative AMP or extended duration AMP. Risk factors for ICs were also investigated. PATIENTS AND METHODS One hundred twenty-three consecutive patients who underwent RC with IUD were divided into 2 groups based on the AMP duration (intraoperative only vs. extended duration for a median of 3 days). Between the groups, the incidence of ICs was compared. Risk factors for ICs were investigated in multivariate analysis. RESULTS The IC rate was 44%. No significant difference was found in the rate of ICs between the groups. The IC rate was significantly higher in patients with lower estimated glomerular filtration rate (eGFR). Rates of ICs were 60 and 38% in patients with eGFR of less than 60 and equal or more than 60 mL/min/1.73 m2, respectively. CONCLUSIONS Our result indicates that AMP that is administered more than intraoperatively may be excessive in RC with IUD. Patients with a lower eGFR should be particularly cared for postoperative ICs.
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Affiliation(s)
- Noboru Numao
- Department of Genitourinary Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan,
| | - Ryo Fujiwara
- Department of Genitourinary Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Sho Uehara
- Department of Urology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shotaro Yasuoka
- Department of Genitourinary Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Motohiro Fujiwara
- Department of Genitourinary Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yoshinobu Komai
- Department of Genitourinary Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takeshi Yuasa
- Department of Genitourinary Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Shinya Yamamoto
- Department of Genitourinary Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Iwao Fukui
- Department of Genitourinary Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Junji Yonese
- Department of Genitourinary Oncology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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Mazzone E, Mistretta FA, Knipper S, Tian Z, Larcher A, Widmer H, Zorn K, Capitanio U, Graefen M, Montorsi F, Shariat SF, Saad F, Briganti A, Karakiewicz PI. Contemporary National Assessment of Robot-Assisted Surgery Rates and Total Hospital Charges for Major Surgical Uro-Oncological Procedures in the United States. J Endourol 2020; 33:438-447. [PMID: 30931607 DOI: 10.1089/end.2018.0840] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: The role of robot assistance is increasingly gaining importance among all major surgical uro-oncological procedures (MSUPs). However, contemporary analyses showed that total hospital charges (THCGs) related to robot-assisted procedures exceed those of open procedures. Based on increasing familiarity with robot-assisted surgery, we postulated that THCGs may have decreased over the past half-decade. Thus, we tested contemporary trends and THCGs related to robot-assisted vs nonrobot-assisted MSUPs. Materials and Methods: Within the National Inpatient Sample database (2009-2015), we identified patients who underwent robot-assisted vs nonrobot-assisted (open or laparoscopic) MSUPs, which included radical prostatectomy (RP), radical nephrectomy (RN), partial nephrectomy (PN), and radical cystectomy (RC). Rates of robot-assisted MSUPs were evaluated using estimated annual percentage changes (EAPCs) analyses. The t-test was used to examine statistically significant differences between mean THCGs according to either robot-assisted or nonrobot-assisted approach. Finally, linear regression analyses were tested for annual variation in the mean THCGs. Results: Of 128,367 MSUPs, 47.7% were robot-assisted. Overall, robot-assisted surgery rates among MSUPs increased from 40.3% to 57.6% (EAPC: +6.3%, p < 0.001) between 2009 and 2015. The mean THCGs for robot-assisted RP, RN, PN, and RC were $13,799, $18,789, $16,574, and $33,575, respectively. The observed mean THCGs differences between robot-assisted and nonrobot-assisted MSUPs were +$1594, +$1592, and +$1829 for RP, RN, and RC, respectively (all p < 0.05). Conversely, no statistically significant difference in the mean THCGs was reported between robot-assisted and nonrobot-assisted PN (+$367, p > 0.05). Finally, the annual observed mean THCGs linearly decreased for all robot-assisted MSUPs during the study period. Conclusions: Rates of robot-assisted MSUPs exponentially increased between 2009 and 2015. Although the mean THCGs decreased in a significant manner during the study period for all MSUPs, THCGs of robot-assisted RP, RN, and RC still exceed those of their respective nonrobot-assisted counterparts. Conversely, no differences in the mean THCGs were reported between robot-assisted vs nonrobot-assisted PN.
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Affiliation(s)
- Elio Mazzone
- 1 Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.,2 Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco A Mistretta
- 1 Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.,3 Department of Urology, European Institute of Oncology, Milan, Italy
| | - Sophie Knipper
- 1 Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.,4 Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Zhe Tian
- 1 Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Alessandro Larcher
- 2 Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Hugues Widmer
- 1 Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.,5 Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
| | - Kevin Zorn
- 1 Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.,5 Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
| | - Umberto Capitanio
- 2 Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Markus Graefen
- 4 Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Francesco Montorsi
- 2 Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | | | - Fred Saad
- 1 Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.,5 Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
| | - Alberto Briganti
- 2 Division of Experimental Oncology/Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy
| | - Pierre I Karakiewicz
- 1 Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada.,5 Division of Urology, University of Montreal Hospital Center (CHUM), Montreal, Quebec, Canada
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Xie W, Bi J, Wei Q, Han P, Song D, Shi L, Ye D, Shen Y, Gou X, He W, Wang S, Liu Z, Fan J, Wu K, Chen Z, Zhou X, Kong C, Liu Y, Liu C, Xu A, Jin B, Fu G, Xue W, Chen H, Pan T, Tu Z, Lin T, Huang J. Survival after radical cystectomy for bladder cancer: Multicenter comparison between minimally invasive and open approaches. Asian J Urol 2020; 7:291-300. [PMID: 32742929 PMCID: PMC7385523 DOI: 10.1016/j.ajur.2020.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/01/2020] [Accepted: 04/26/2020] [Indexed: 02/08/2023] Open
Abstract
Objective To investigate oncological outcomes in patients with bladder cancer who underwent minimally invasive radical cystectomy (MIRC) or open radical cystectomy (ORC). Methods We identified patients with bladder cancer who underwent radical cystectomy (RC) in 13 centers of the Chinese Bladder Cancer Consortium (CBCC). Perioperative outcomes were compared between MIRC and ORC. The influence of surgical approaches on overall survival (OS) and cancer-specific survival (CSS) in the entire study group and subgroups classified according to pathologic stage or lymph node (LN) status was assessed with the log-rank test. Multivariable Cox proportional hazard models were used to evaluate the association among OS, CSS and risk factors of interest. Results Of 2 098 patients who underwent RC, 1 243 patients underwent MIRC (1 087 laparoscopic RC and 156 robotic-assisted RC, respectively), while 855 patients underwent ORC. No significant differences were noted in positive surgical margin rate and 90-day postoperative mortality rate. MIRC was associated with less estimated blood loss, more LN yield, higher rate of neobladder diversion, longer operative time, and longer length of hospital stay. There was no significant difference in OS and CSS according to surgical approaches (p=0.653, and 0.816, respectively). Subgroup analysis revealed that OS and CSS were not significantly different regardless of the status of extravesical involvement or LN involvement. Multivariable Cox regression analyses showed that the surgical approach was not a significant predictor of OS and CSS. Conclusions Our study showed that MIRC was comparable to conventional ORC in terms of OS and CSS.
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Affiliation(s)
- Weibin Xie
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Junming Bi
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Qiang Wei
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Ping Han
- Department of Urology, West China Hospital, Sichuan University, Chengdu, China
| | - Dongkui Song
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lei Shi
- Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dingwei Ye
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Yijun Shen
- Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xin Gou
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Weiyang He
- Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shaogang Wang
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zheng Liu
- Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jinhai Fan
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Kaijie Wu
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zhiwen Chen
- Department of Urology, First Affiliated Hospital of Army Medical University, Urology Institute of People Liberation Army, Chongqing, China
| | - Xiaozhou Zhou
- Department of Urology, First Affiliated Hospital of Army Medical University, Urology Institute of People Liberation Army, Chongqing, China
| | - Chuize Kong
- Department of Urology, The First Hospital of China Medical University, Shenyang, China
| | - Yang Liu
- Department of Urology, The First Hospital of China Medical University, Shenyang, China
| | - Chunxiao Liu
- Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Abai Xu
- Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Baiye Jin
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Guanghou Fu
- Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wei Xue
- Department of Urology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Haige Chen
- Department of Urology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Tiejun Pan
- Department of Urology, General Hospital of Central Theater Command of the People's Liberation Army, Wuhan, China
| | - Zhong Tu
- Department of Urology, General Hospital of Central Theater Command of the People's Liberation Army, Wuhan, China
| | - Tianxin Lin
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Jian Huang
- Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
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Peng L, Li J, Cao D, Ren Z, Wei T, You C, Cheng B, Wei Q, Li Y. Can robotic-assisted radical cystectomy provide patients with a smaller trauma and faster recovery period? A systematic review and meta-analysis of comparative trials. J Cancer Res Clin Oncol 2020; 146:1591-1601. [PMID: 32185487 DOI: 10.1007/s00432-020-03183-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 03/11/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This article explores the differences in the effectiveness and safety of the treatment of bladder cancer (BC) by robotic-assisted radical cystectomy (RARC) and laparoscopic radical cystectomy (LRC). METHODS A systematic search was performed using databases including Medline, PubMed and Web of Science within a limited period from January 1, 2000, to September 1, 2019. RevMan 5.3 was used for calculation and statistical analyses. RESULTS We performed meta-analysis on operation time, estimated blood loss, intraoperative blood transfusion, positive surgical margin, oral intake time, length of hospital stay, complication and other indicators, and found that there were no statistically significant differences between LRC and RARC. CONCLUSION Our meta-analysis results show that LRC and RARC have similar results on the effectiveness and safety of BC. For those medical institutions that cannot perform robot-assisted surgery but are seeking minimally invasive and faster postoperative recovery, LRC is worth considering. However, a larger sample size, more rigorous design and longer follow-up randomized controlled trials are still needed to support our conclusions.
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Affiliation(s)
- Lei Peng
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, People's Republic of China
| | - Jinze Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, People's Republic of China
| | - Dehong Cao
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
- State Key Laboratory of Biotherapy and Cancer Center, Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Zhengju Ren
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
- State Key Laboratory of Biotherapy and Cancer Center, Collaborative Innovation Center for Biotherapy, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Tangqiang Wei
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, People's Republic of China
| | - Chengyu You
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, People's Republic of China
| | - Bo Cheng
- Department of Neurology, The Affiliated Hospital of Medical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, People's Republic of China
| | - Qiang Wei
- Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Chengdu, 610041, People's Republic of China
| | - Yunxiang Li
- Department of Urology, Nanchong Central Hospital, The Second Clinical College, North Sichuan Medical College (University), Nanchong, 63700, Sichuan, People's Republic of China.
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Khalil MI, Tourchi A, Langford BT, Bhandari NR, Payakachat N, Davis R, Safaan A, Raheem OA, Kamel MH. Early Postoperative Morbidity of Robotic Versus Open Radical Cystectomy in Obese Patients. J Endourol 2020; 34:461-468. [PMID: 31964189 DOI: 10.1089/end.2019.0560] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aims: To compare the 30-day postoperative complications of robotic radical cystectomy (RRC) vs open radical cystectomy (ORC) in obese patients (body mass index ≥30) with bladder cancer (BC). Methods: The National Surgical Quality Improvement Program database was queried to identify obese BC patients who underwent RRC or ORC between 2005 and 2016. Patient demographics, postoperative mortality rate, morbidity, operating time (OPTIME), length of stay (LOS), readmission, and reoperation rates were recorded and compared between the two groups. Each RRC patient was matched with three ORC patients using a propensity score approach. Results: Four hundred forty-two RRC patients were matched with 1326 ORC patients. No difference in early postoperative mortality rate between RRC and ORC (0.7% vs 1.3%, relative risk, RR [95% confidence interval CI]: 0.27 [0.07-1.02]). Compared with ORC, the RRC group showed shorter mean OPTIME (364.7 [standard deviation, SD = 133.4] vs 387.8 [SD = 129.7] minutes, p = 0.001) and mean LOS (7.1 [SD = 5.6] vs 10.6 [SD = 6.6] days, p < 0.001). Compared with ORC, the RR of developing the following events in RRC group was lower: 30-day postoperative any complication (45%), any wound occurrence (64%), blood transfusion (70%), superficial surgical-site infection (78%), and wound disruption (77%). There was no difference in the RR of any-cause readmission (RR [95% CI]: 0.77 [0.57-1.05]) and reoperation (RR [95% CI]: 0.48 [0.22-1.04]) between the two groups. Conclusions: The study revealed that RRC for obese BC patients is associated with shorter OPTIME, shorter LOS, and lower risk of early postoperative complications when compared with a matched group of patients who received ORC. In addition, no difference in early postoperative mortality rate between RRC and ORC was observed.
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Affiliation(s)
- Mahmoud I Khalil
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Department of Urology, Ain Shams University, Cairo, Egypt
| | - Ali Tourchi
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Brian T Langford
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Naleen Raj Bhandari
- Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Nalin Payakachat
- Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Rodney Davis
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Ahmed Safaan
- Department of Urology, Ain Shams University, Cairo, Egypt
| | - Omer A Raheem
- Department of Urology, Tulane University, New Orleans, Louisiana, USA
| | - Mohamed H Kamel
- Department of Urology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.,Department of Urology, Ain Shams University, Cairo, Egypt
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Albisinni S, Veccia A, Aoun F, Diamand R, Esperto F, Porpiglia F, Roumeguère T, De Nunzio C. A systematic review and meta-analysis comparing the outcomes of open and robotic assisted radical cystectomy. MINERVA UROL NEFROL 2019; 71:553-568. [DOI: 10.23736/s0393-2249.19.03546-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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30
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Robot Assisted Radical Cystectomy vs Open Radical Cystectomy: Over 10 years of the Mayo Clinic Experience. Urol Oncol 2019; 37:862-869. [DOI: 10.1016/j.urolonc.2019.07.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/10/2019] [Accepted: 07/25/2019] [Indexed: 01/22/2023]
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31
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Lenfant L, Campi R, Parra J, Graffeille V, Masson-Lecomte A, Vordos D, de La Taille A, Roumiguie M, Lesourd M, Taksin L, Misraï V, Granger B, Ploussard G, Vaessen C, Verhoest G, Rouprêt M. Robotic versus open radical cystectomy throughout the learning phase: insights from a real-life multicenter study. World J Urol 2019; 38:1951-1958. [PMID: 31720765 DOI: 10.1007/s00345-019-02998-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/24/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Robot-assisted radical cystectomy (RARC) has been shown to be non-inferior to open radical cystectomy (ORC) for the treatment of bladder cancer (BC). However, most data on RARC come from high-volume surgeons at high-volume centers. The objective of the study was to compare perioperative and mid-term oncologic outcomes of RARC versus ORC in a real-life cohort of patients treated by surgeons starting their experience with RARC. MATERIALS AND METHODS Data were prospectively collected from consecutive patients undergoing RARC and ORC at five referral Centers between 2010 and 2016 by five surgeons (one per center) with no prior experience in RARC. Patients with high-risk non-muscle-invasive or organ-confined muscle-invasive (T2N0M0) bladder cancer were considered for RARC. The main study endpoints were perioperative outcomes, postoperative surgical complications, and mid-term oncologic outcomes. RESULTS Overall, 124 and 118 patients underwent RARC and ORC, respectively. Baseline patients' and tumors' characteristics were comparable between the two groups. Yet, the proportion of patients receiving neoadjuvant chemotherapy was significantly higher in the RARC cohort. Median operative time was significantly higher, while median EBL, LOH, and transfusion rates were significantly lower after RARC. Median number of lymph nodes removed was significantly higher after RARC. All other histopathological outcomes, as well as the rate of early (< 30 days) and late postoperative complications, were comparable to ORC. At a median follow-up of 2 years, 29 (23%) and 41 (35%) patients developed disease recurrence (p = 0.05), while 20 (16%) and 37 (31%) died of bladder cancer (p = 0.005) after RARC and ORC, respectively. CONCLUSIONS With proper patient selection, RARC was non-inferior to ORC throughout the surgeons' learning phase. Yet, the observed differences in oncologic outcomes suggest selection bias toward adoption of RARC for patients with more favorable disease characteristics.
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Affiliation(s)
- Louis Lenfant
- Sorbonne University, Hopital Pitié Salpétrière, Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Riccardo Campi
- Sorbonne University, Hopital Pitié Salpétrière, Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Jérôme Parra
- Sorbonne University, Hopital Pitié Salpétrière, Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Vivien Graffeille
- Department of Urology, Pontchaillou Hospital, CHU RENNES, Rennes, France
| | - Alexandra Masson-Lecomte
- Department of Urology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) CHU Mondor, Faculté de Médecine, Créteil, France
| | - Dimitri Vordos
- Department of Urology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) CHU Mondor, Faculté de Médecine, Créteil, France
| | - Alexandre de La Taille
- Department of Urology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) CHU Mondor, Faculté de Médecine, Créteil, France
| | - Mathieu Roumiguie
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, 1, av J Pouilhès, 31059, Toulouse Cedex, France
| | - Marine Lesourd
- Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, 1, av J Pouilhès, 31059, Toulouse Cedex, France
| | - Lionel Taksin
- Hôpital privé d'Antony, 1 rue Velpeau, 92160, Antony, France
| | - Vincent Misraï
- Clinique Pasteur, 45 Avenue de Lombez, 31300, Toulouse, France
| | - Benjamin Granger
- Department of Biostatistics, Groupe Hospitalo-Universitaire EST, Faculté de Médecine Pierre et Marie Curie, Pitié-Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Paris Sorbonne, Paris, France
| | | | - Christophe Vaessen
- Sorbonne University, Hopital Pitié Salpétrière, Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Gregory Verhoest
- Department of Urology, Pontchaillou Hospital, CHU RENNES, Rennes, France
| | - Morgan Rouprêt
- Sorbonne University, Hopital Pitié Salpétrière, Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.
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A Population-based Study of Ureteroenteric Strictures After Open and Robot-assisted Radical Cystectomy. Urology 2019; 135:57-65. [PMID: 31618656 DOI: 10.1016/j.urology.2019.07.054] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 06/25/2019] [Accepted: 07/18/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate differences in the incidence of benign ureteroenteric stricture, we compared stricture rates of robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC) using Surveillance, Epidemiology, and End Results-Medicare data. METHODS We identified 332 RARC and 1449 ORC performed between 2009 and 2014 to determine stricture rates at 6, 12, and 24 months following surgery. We defined ureteroenteric stricture as the need for procedural intervention. Additionally, we compared the incidence of stricture diagnosis. Multivariable proportional hazards regression was performed to determine factors associated with stricture development. RESULTS The incidence of ureteroenteric stricture at 6 and 12 months was higher for RARC vs ORC at 12.1% vs 7.0% (P < .01) and 15.0% vs 9.5% (P = .01), respectively. RARC vs ORC stricture incidence at 2 years did not differ significantly at 14.6% vs 11.4% (P = .29). Similarly, the stricture diagnosis rates were significantly lower following ORC at 6, 12, and 24 months (P < .05). In adjusted analysis, RARC (HR 1.64, 95%CI 1.23-2.19) and preoperative hydronephrosis (HR 1.51, 95% CI 1.17-1.94) were associated with the development of stricture. Higher hospital volume was associated with a lower risk of stricture (HR 0.40, 95%CI 0.26-0.63). CONCLUSION RARC is associated with a higher rate of ureteroenteric stricture diagnosis and intervention on a population-based level that is mitigated by higher hospital volume. A significant study limitation is inability to differentiate extracorporeal vs intracorporeal diversion. However, a stricture complication compounds the financial burden of care and efforts must be pursued to improve this surgical outcome.
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Tae JH, Pyun JH, Shim JS, Cho S, Kang SG, Ko YH, Cheon J, Lee JG, Kang SH. Oncological and functional outcomes of robot-assisted radical cystectomy in bladder cancer patients in a single tertiary center: Can these be preserved throughout the learning curve? Investig Clin Urol 2019; 60:463-471. [PMID: 31692995 PMCID: PMC6821988 DOI: 10.4111/icu.2019.60.6.463] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/04/2019] [Indexed: 11/28/2022] Open
Abstract
Purpose To evaluate the overall and segmental oncological and functional outcome of robot-assisted radical cystectomy (RARC) during the learning curve. Materials and Methods From August 2007 to November 2017, a total of 120 bladder cancer patients were treated with RARC in a single-tertiary hospital. These were divided into three groups of 40 consecutive cases. Overall and subgroup analysis of each group was used to evaluate oncological and functional outcomes throughout the learning curve. Results Among the 120 RARC cases, 42, 73, and 5 patients received extracorporeal urinary diversion (ECUD), intracorporeal urinary diversion (ICUD), and ureterocutaneostomy, respectively. There was a transition from ECUD to ICUD during the learning curve. The positive surgical margin rate was 0.8%. The mean lymph node yield for the standard and extended pelvic lymph node dissection was 12.5 and 30.1, respectively, and increased to 19.8 and 31.2 and further to 20.0 and 37.9, respectively, with each additional series of 40 cases. The 5-year overall survival and 3-year recurrence-free survival rates were 86.6% and 81.4%, respectively. The 1-year daytime continence rate was 75.7%, while the nighttime continence rate was 51.4%. The potency preservation rate was 66.7% (n=8) with or without phosphodiesterase-5 inhibitors (PDE5-I) at 1 year and 33.3% without PDE5-I (n=4). Conclusions RARC results in comparable oncological and functional outcomes to open radical cystectomy. In addition, the oncological and functional outcomes were well maintained throughout the learning curve. ECUD transition to ICUD was safe and did not compromise oncological or functional outcome.
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Affiliation(s)
- Jong Hyun Tae
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Jong Hyun Pyun
- Department of Urology, Kangbuk Samsung Hospital, Seoul, Korea
| | - Ji Sung Shim
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Seok Cho
- Department of Urology, Inje University Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Sung Gu Kang
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Young Hwii Ko
- Department of Urology, Yeungnam University College of Medicine, Daegu, Korea
| | - Jun Cheon
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Jeong Gu Lee
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
| | - Seok Ho Kang
- Department of Urology, Korea University Medical Center, Korea University School of Medicine, Seoul, Korea
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Miguel CM, Kosinski KE, Fazzari MJ, Kongnyuy M, Smaldone MC, Schiff JT, Katz AE, Corcoran AT. Pathologic measures of quality compare favorably in patients undergoing robot-assisted radical cystectomy to open cystectomy cohorts: a National Cancer Database analysis. J Robot Surg 2019; 14:609-614. [DOI: 10.1007/s11701-019-01031-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 09/23/2019] [Indexed: 10/25/2022]
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Zamboni S, Soria F, Mathieu R, Xylinas E, Abufaraj M, D Andrea D, Tan WS, Kelly JD, Simone G, Gallucci M, Meraney A, Krishna S, Konety BR, Antonelli A, Simeone C, Baumeister P, Mattei A, Briganti A, Gallina A, Montorsi F, Rink M, Aziz A, Karakiewicz PI, Rouprêt M, Koupparis A, Scherr DS, Ploussard G, Sooriakumaran P, Shariat SF, Moschini M. Differences in trends in the use of robot-assisted and open radical cystectomy and changes over time in peri-operative outcomes among selected centres in North America and Europe: an international multicentre collaboration. BJU Int 2019; 124:656-664. [PMID: 31055865 DOI: 10.1111/bju.14791] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVES To compare trends in the use of robot-assisted radical cystectomy (RARC) and changes over time in peri-operative outcomes in selected North American and European centres. MATERIALS AND METHODS We conducted a retrospective evaluation of 2401 patients treated with open radical cystectomy (ORC) or RARC for bladder cancer at 12 centres in North America and Europe between 2006 and 2018. We used the Kruskal-Wallis and chi-squared test to evaluate differences between continuous and categorical variables. RESULTS Overall, 49.5% of patients underwent RARC and 51.5% ORC. RARC became the most commonly performed procedure in contemporary patients, with an increase from 29% in 2006-2008 to 54% in 2015-2018 (P < 0.001). In the North American centres the use of RARC was higher than that of ORC from 2006, and remained stable over time, whereas in the European centres its use increased exponentially from 2% to 50%. In both groups patients who underwent RARC had less advanced T stages (P < 0.001), lower American Society of Anesthesiologists scores (P < 0.05), lower blood loss (P = 0.001) and shorter length of hospital stay (P < 0.05). No differences were found in early complications. Early readmission and re-operation rates were worse for patients treated with RARC in the European centres; however, when contemporary patients only were considered, the statistical significance was lost. CONCLUSION The present study shows that the use of RARC has constantly increased since its introduction, overtaking ORC in the most contemporary series. While RARC was more frequently performed than ORC since its introduction in the North American centres and its use remained substantially stable over time, its use increased exponentially in the European centres. The different trends in use of RARC/ORC and changes over time in peri-operative outcomes between the North American and European centres can be attributed to the earlier introduction and spread of RARC in the former compared with the latter.
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Affiliation(s)
- Stefania Zamboni
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.,Urology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili, University of Brescia, Vienna, Austria
| | - Francesco Soria
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.,Division of Urology, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy
| | - Romain Mathieu
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.,Department of Urology, Rennes University Hospital, Rennes, France
| | - Evanguelos Xylinas
- Department of Urology Bichat Hospital, Paris Descartes University, Paris, France
| | - Mohammad Abufaraj
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.,Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - David D Andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Wei Shen Tan
- Division of Surgery and Intervention Science, University College London, London, UK.,Department of Urology, University College London Hospital, London, UK.,Department of Uro-oncology, University College London Hospital NHS Foundation Trust, London, UK
| | - John D Kelly
- Division of Surgery and Intervention Science, University College London, London, UK.,Department of Urology, University College London Hospital, London, UK.,Department of Uro-oncology, University College London Hospital NHS Foundation Trust, London, UK
| | - Giuseppe Simone
- Department of Urology, "ReginaElena" National Cancer Institute, Rome, Italy
| | - Michele Gallucci
- Department of Urology, "ReginaElena" National Cancer Institute, Rome, Italy
| | - Anoop Meraney
- Urology Division, Hartford Healthcare Medical Group, Hartford, CT, USA
| | - Suprita Krishna
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | | | - Alessandro Antonelli
- Urology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili, University of Brescia, Vienna, Austria
| | - Claudio Simeone
- Urology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili, University of Brescia, Vienna, Austria
| | | | - Agostino Mattei
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Andrea Gallina
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Montorsi
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Atiqullah Aziz
- Department of Urology, University Medical Center Rostock, Rostock, Germany
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada
| | - Morgan Rouprêt
- GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France
| | - Anthony Koupparis
- Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Douglas S Scherr
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA
| | | | - Prasanna Sooriakumaran
- Department of Uro-oncology, University College London Hospital NHS Foundation Trust, London, UK.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.,Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.,Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Marco Moschini
- Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.,Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
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- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
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Moschini M, Zamboni S, Soria F, Mathieu R, Xylinas E, Tan WS, Kelly JD, Simone G, Meraney A, Krishna S, Konety B, Mattei A, Baumeister P, Mordasini L, Montorsi F, Briganti A, Gallina A, Stabile A, Sanchez-Salas R, Cathelineau X, Rink M, Necchi A, Karakiewicz PI, Rouprêt M, Koupparis A, Kassouf W, Scherr DS, Ploussard G, Boorjian SA, Lotan Y, Sooriakumaran P, Shariat SF. Open Versus Robotic Cystectomy: A Propensity Score Matched Analysis Comparing Survival Outcomes. J Clin Med 2019; 8:jcm8081192. [PMID: 31395826 PMCID: PMC6722857 DOI: 10.3390/jcm8081192] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 07/15/2019] [Accepted: 08/06/2019] [Indexed: 01/17/2023] Open
Abstract
Background: To assess the differential effect of robotic assisted radical cystectomy (RARC) versus open radical cystectomy (ORC) on survival outcomes in matched analyses performed on a large multicentric cohort. Methods: The study included 9757 patients with urothelial bladder cancer (BCa) treated in a consecutive manner at each of 25 institutions. All patients underwent radical cystectomy with bilateral pelvic lymphadenectomy. To adjust for potential selection bias, propensity score matching 2:1 was performed with two ORC patients matched to one RARC patient. The propensity-matched cohort included 1374 patients. Multivariable competing risk analyses accounting for death of other causes, tested association of surgical technique with recurrence and cancer specific mortality (CSM), before and after propensity score matching. Results: Overall, 767 (7.8%) patients underwent RARC and 8990 (92.2%) ORC. The median follow-up before and after propensity matching was 81 and 102 months, respectively. In the overall population, the 3-year recurrence rates and CSM were 37% vs. 26% and 34% vs. 24% for ORC vs. RARC (all p values > 0.1), respectively. On multivariable Cox regression analyses, RARC and ORC had similar recurrence and CSM rates before and after matching (all p values > 0.1). Conclusions: Patients treated with RARC and ORC have similar survival outcomes. This data is helpful in consulting patients until long term survival outcomes of level one evidence is available.
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Affiliation(s)
- Marco Moschini
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, A-1090 Vienna, Austria
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, 20132 Milan, Italy
- Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland
| | - Stefania Zamboni
- Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland
| | - Francesco Soria
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, A-1090 Vienna, Austria
- Division of Urology, Department of Surgical Sciences, University of Studies of Torino, 10124 Turin, Italy
| | - Romain Mathieu
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, A-1090 Vienna, Austria
- Department of Urology, Rennes University Hospital, 35000 Rennes, France
| | - Evanguelos Xylinas
- Department of Urology Bichat Hospital, Paris Descartes University, 75877 Paris, France
| | - Wei Shen Tan
- Division of Surgery and Intervention Science, University College London, London WC1E 6BT, UK
- Department of Uro-Oncology, University College London Hospital NHS Foundation Trust, London W1T 4EU, UK
| | - John D Kelly
- Division of Surgery and Intervention Science, University College London, London WC1E 6BT, UK
- Department of Uro-Oncology, University College London Hospital NHS Foundation Trust, London W1T 4EU, UK
| | - Giuseppe Simone
- Department of Urology, "Regina Elena" National Cancer Institute, 00128 Rome, Italy
| | - Anoop Meraney
- Urology Division, Hartford Healthcare Medical Group, Hartford, CT 06106, USA
| | - Suprita Krishna
- Department of Urology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Badrinath Konety
- Department of Urology, University of Minnesota, Minneapolis, MN 55455, USA
| | - Agostino Mattei
- Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland
| | - Philipp Baumeister
- Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland
| | - Livio Mordasini
- Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland
| | - Francesco Montorsi
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Alberto Briganti
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Andrea Gallina
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Armando Stabile
- Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Rafael Sanchez-Salas
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, 75014 Paris, France
| | - Xavier Cathelineau
- Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, 75014 Paris, France
| | - Michael Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany
| | - Andrea Necchi
- Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC H4A 3J1, Canada
| | - Morgan Rouprêt
- Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, F-75013 Paris, France
| | - Anthony Koupparis
- Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, UK
| | - Wassim Kassouf
- Department of Urology, McGill University Health Center, Montreal, QC H4A3J1, Canada
| | - Douglas S Scherr
- Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY 10038, USA
| | | | - Stephen A Boorjian
- Department of Urology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Prasanna Sooriakumaran
- Department of Uro-Oncology, University College London Hospital NHS Foundation Trust, London W1T 4EU, UK
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 17177 Stockholm, Sweden
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, A-1090 Vienna, Austria.
- Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY 10021, USA.
- Department of Urology, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030, USA.
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Teishima J, Matsubara A. Editorial Comment to Current status and future perspective of robot-assisted radical cystectomy for invasive bladder cancer. Int J Urol 2019; 26:1042-1043. [PMID: 31364188 DOI: 10.1111/iju.14086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Jun Teishima
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akio Matsubara
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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38
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Fujimura T. Current status and future perspective of robot-assisted radical cystectomy for invasive bladder cancer. Int J Urol 2019; 26:1033-1042. [PMID: 31364203 DOI: 10.1111/iju.14076] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 06/30/2019] [Indexed: 12/21/2022]
Abstract
The current status of robot-assisted radical cystectomy was reviewed 16 years after the initial robot-assisted radical cystectomy for the treatment of invasive bladder cancer. Articles associated with robot-assisted radical cystectomy and written in English were selected from the PubMed database from January 2003 to February 2019. The present review article focused on the distribution of robot-assisted radical cystectomy, patient selection, preoperative management, surgical technique, lymph node dissection, urinary diversion, recurrence pattern, oncological outcomes, cost, learning curve, complications and educational programs. A total of 400 articles were divided according to the country of the first author's affiliation. The USA was the most dominant at 198 (50%), whereas the number of articles from the countries belonging to the Urological Association of Asia was 15 (3.8%) for China, 17 (4.3%) for South Korea, 10 (2.5%) for Japan, eight (2%) for Taiwan, eight (2%) for Turkey and one (0.2%) for Iran. The percentage of robot-assisted radical cystectomy carried out is increasing, and intracorporeal urinary diversion and ileal neobladder are also frequently carried out. With a refined technique being performed in high-volume centers, robot-assisted radical cystectomy has contributed to the reduction in transfusion rate, length of stay and severe complications; however, it has not yet shown any cancer-specific survival benefits. Robot-assisted radical cystectomy is not fully spread throughout the Urological Association of Asia. Further investigation with respect to worldwide results is needed to prove the real benefit of robot-assisted radical cystectomy regarding low morbidity, reduced total medical cost, and survival benefit. In the era of precision medicine, appropriate drug and surgery will be given based on each genetic profile.
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Affiliation(s)
- Tetsuya Fujimura
- Department of Urology, Jichi Medical University, Shimotsuke, Tochigi, Japan
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Tzelves L, Skolarikos A, Mourmouris P, Lazarou L, Kostakopoulos N, Manatakis DK, Kural AR. Does the Use of a Robot Decrease the Complication Rate Adherent to Radical Cystectomy? A Systematic Review and Meta-Analysis of Studies Comparing Open with Robotic Counterparts. J Endourol 2019; 33:971-984. [PMID: 31161777 DOI: 10.1089/end.2019.0226] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Introduction: Radical cystectomy (RC) is the mainstay of treatment for muscle-invasive bladder cancer. In 2003, the first robot-assisted radical cystectomy (RARC) was performed and since then many studies, mainly observational, were conducted to compare robotic and open methods. This study aims to assess perioperative outcomes between the two methods based on pooled data from existing literature. Methods: A literature search of articles in English and French languages was performed in three databases (Medline, Embase, and Cochrane) until 30th of June 2018, as well as in urology conference programs and reference lists of included studies. The study protocol was registered at PROSPERO (CRD42018103063). Terms such as "robotic," "open," and "radical cystectomy" and synonyms were used for the searching algorithm. The primary outcome was the number of minor and major postoperative complications (Clavien grading system). Risk of bias was assessed with the Cochrane tool and Newcastle-Ottawa scale. Comparison of continuous outcomes was performed with weighted mean differences, while for dichotomous outcomes, odds ratios (ORs) were used. Review Manager 5.3 was used. Results: Fifty-four studies (5 randomized trials and 49 observational) were eligible, including 29,697 patients (6500 in the RARC group and 23,197 in the open radical cystectomy group). Minor complications (grade 1-2) in pooled data of 29 studies were fewer in the RARC group (OR = 0.54, 95% confidence interval [CI]: 0.38-0.76, p < 0.001), a difference persisting after sensitivity analysis for 30 and 90 days. Major complications (grade 3-5) in 31 studies were fewer in the RARC group (OR = 0.78, 95% CI: 0.65-0.94, p = 0.009), but this difference disappeared in the 30-day subanalysis. RARC was associated with lower blood transfusion rates (p < 0.001), lower length of stay (p < 0.001), faster return to regular diet (p < 0.001), and lower postoperative mortality rates (p < 0.001), but longer operating time. Conclusions: RARC appears to be associated with fewer complications and favoring perioperative outcomes in comparison with the open method. Due to the observational nature of most studies, larger randomized trials are needed to confirm these findings.
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Affiliation(s)
- Lazaros Tzelves
- 2nd Department of Urology, Sismanoglio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Andreas Skolarikos
- 2nd Department of Urology, Sismanoglio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Mourmouris
- 2nd Department of Urology, Sismanoglio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Lazaros Lazarou
- 2nd Department of Urology, Sismanoglio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Nikolaos Kostakopoulos
- 2nd Department of Urology, Sismanoglio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Ali Riza Kural
- Department of Urology, School of Medicine, Acibadem Maslak Hospital, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
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Su S, Gu L, Ma X, Li H, Wang B, Shi T, Zhang X. Comparison of Laparoscopic and Robot-assisted Radical Cystectomy for Bladder Cancer: Perioperative and Oncologic Outcomes. Clin Genitourin Cancer 2019; 17:e1048-e1053. [PMID: 31303560 DOI: 10.1016/j.clgc.2019.06.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 05/01/2019] [Accepted: 06/07/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The purpose of this study was to compare perioperative and oncologic outcomes between laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) for bladder cancer (BCa). MATERIALS AND METHODS Patients who underwent LRC or RARC with curative intent for BCa between January 2011 and December 2016 were included. Perioperative, pathologic oncologic data were extracted from our database. Disease-free survival, overall survival, and cancer-specific survival were analyzed using Kaplan-Meier survival curves with log-rank tests. RESULTS A total of 126 patients underwent LRC and 189 patients underwent RARC during the study period. All the baseline variables were similar between the two groups. Patients undergoing RARC had a significant higher median estimated blood loss (300 mL vs. 200 mL; P = .005), lower rate of 90-day postoperative complications (36.5% vs. 50.0%; P = .017), and higher median direct cost ($15,306 vs. $11,131; P < .001) than LRC. Other perioperative outcomes were similar. No differences were found in pathologic T stage, positive lymph nodes, or positive surgical margin between patients who underwent LRC and RARC. The 5-year disease-free survival, overall survival, and cancer-specific survival rates were 51.9%, 61.0%, and 69.5%, respectively, for all included patients. There were no significant differences in oncologic outcomes between the 2 groups. CONCLUSION Patients with BCa can be safely managed with LRC and RARC by experienced surgeons. RARC was associated with a reduced rate of postoperative complication but also with higher median estimated blood loss, and higher median direct cost. These findings could be used to guide patient counseling, and treatment selection.
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Affiliation(s)
- Shiqiang Su
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China; Department of Urology, The First Hospital of Shijiazhuang, Shijiazhuang, China
| | - Liangyou Gu
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Xin Ma
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Hongzhao Li
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Baojun Wang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Taoping Shi
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China
| | - Xu Zhang
- Department of Urology/State Key Laboratory of Kidney Diseases, Chinese PLA General Hospital/PLA Medical School, Beijing, China.
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Gandaglia G, Larcher A, Gallina A, Fossati N, Briganti A, Montorsi F. Requiem for Open Radical Cystectomy in Bladder Cancer Patients. Eur Urol Oncol 2019; 2:196-197. [PMID: 31017096 DOI: 10.1016/j.euo.2018.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 07/11/2018] [Indexed: 12/25/2022]
Abstract
In the hands of experienced surgeons at referral centers, robotic surgery with an intracorporeal urinary diversion has the potential to provide better perioperative outcomes without affecting cancer control when compared to open surgery for radical cystectomy.
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Affiliation(s)
- Giorgio Gandaglia
- Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Alessandro Larcher
- Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Gallina
- Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nicola Fossati
- Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Alberto Briganti
- Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Francesco Montorsi
- Unit of Urology, Division of Oncology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
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Mazzone E, Preisser F, Nazzani S, Tian Z, Zaffuto E, Gallina A, Tilki D, Montorsi F, Shariat SF, Saad F, Briganti A, Karakiewicz PI. The effect of age and comorbidities on early postoperative complications after radical cystectomy: A contemporary population-based analysis. J Geriatr Oncol 2019; 10:623-631. [PMID: 31010691 DOI: 10.1016/j.jgo.2019.04.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/14/2019] [Accepted: 04/14/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Analyzing the relationship between perioperative outcomes and age in urothelial carcinoma of the bladder (UCB) patients treated with radical cystectomy (RC) in a continuous fashion may provide detailed information on the increased risk of complications in older patients, even after accounting for different comorbidity profiles. Given the limited data available in the literature, we tested these relationships within a large scale, population-based database. MATERIALS AND METHODS Within the NIS database (2003-2015), we identified patients who underwent RC for UCB. Multivariable logistic regression (MLoR) and Poisson regression (MPR) models were used after adjustment for clustering and stratification for comorbidity profiles. RESULTS Overall, 20,144 patients underwent RC with a median age of 70 years (interquartile range: 62-77). In MLoR models, continuously coded age represented an independent predictor of overall (odds ratio [OR]: 1.008, 95%-confidence interval [CI]: 1.005-1.012), cardiac (OR: 1.042, 95%-CI: 1.035-1.049), vascular (OR: 1.024, 95%-CI: 1.014-1.034), respiratory (OR: 1.016, 95%-CI 1.009-1.022), miscellaneous medical (OR: 1.013, 95%-CI: 1.009-1.017), infectious (OR: 1.012, 95%-CI 1.004-1.019), transfusions (OR: 1.011, 95%-CI 1.007-1.015) and bowel obstruction (OR: 1.009, 95%-CI 1.004-1.013) complications, and in-hospital mortality (OR: 1.057, 95%-CI 1.039-1.075). Conversely, patients age did not predict intraoperative (p = 0.7), genitourinary (p = 0.9), operative wound (p = 0.2) and miscellaneous surgical complications (p = 0.1). In MPR models, patients age predicted longer LOS (relative risk [RR]: 1.002, 95%-CI 1.001-1.003). Finally, a decreasing effect of age was observed in patients low vs high comorbidity burden for cardiac, respiratory and overall complications. CONCLUSIONS Most of early postoperative RC complications are related to patients age, but its impact varies according to comorbidity profile. Further studies are needed to validate our findings that may be then considered for individual counselling and informed consent, as well as for health expenditure planning.
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Affiliation(s)
- Elio Mazzone
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Division of Experimental Oncology, Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Felix Preisser
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sebastiano Nazzani
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada; Academic Department of Urology, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Zhe Tian
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Emanuele Zaffuto
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Gallina
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Derya Tilki
- Martini Klinik, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Urology, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Francesco Montorsi
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | | | - Fred Saad
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
| | - Alberto Briganti
- Division of Experimental Oncology, Unit of Urology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Pierre I Karakiewicz
- Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, Quebec, Canada
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Oncologic outcomes after robot-assisted versus open radical cystectomy: a systematic review and meta-analysis. World J Urol 2019; 37:1557-1570. [PMID: 30976902 DOI: 10.1007/s00345-019-02708-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 02/26/2019] [Indexed: 10/27/2022] Open
Abstract
PURPOSE The efficacy of RARC in oncologic outcomes compared ORC is controversial. We assess potential differences in oncologic outcomes between robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC). METHODS We performed the literature search systematically according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. A pooled meta-analysis was performed to assess the difference in oncologic outcomes between RARC and ORC, separately in randomized controlled trials (RCTs) and non-randomized studies (NRCTs). RESULTS Five RCTs and 28 NRCTs were included in this systematic review and meta-analysis. There was no difference in the rate of overall positive surgical margin (PSM) in RCTs, while NRCTs showed a lower rate for RARC. There was no difference in the soft tissue PSM rate between RARC and ORC in both RCTs and NRCTs. There was no difference in the lymph node yield by standard and extended lymph node dissection between RARC and ORC in both RCTs and NRCTs. There was no significant difference in survival outcomes between RARC and ORC in both RCTs and NRCTs. CONCLUSIONS Based on the current evidence, there is no difference in the rate of PSMs, lymph node yield, recurrence rate and location as well as short-term survival outcomes between RARC and ORC in RCTs. In NRCTs, only PSM rates were better for RARC compared to ORC, but this was likely due to selection and reporting bias which are inherent to retrospective study designs.
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Moschini M, Soria F, Mathieu R, Xylinas E, D'Andrea D, Tan WS, Kelly JD, Simone G, Tuderti G, Meraney A, Krishna S, Konety B, Zamboni S, Baumeister P, Mattei A, Briganti A, Montorsi F, Galucci M, Rink M, Karakiewicz PI, Rouprêt M, Aziz A, Perry M, Rowe E, Koupparis A, Kassouf W, Scherr DS, Ploussard G, Boorjian SA, Sooriakumaran P, Shariat SF. Propensity-score-matched comparison of soft tissue surgical margins status between open and robotic-assisted radical cystectomy. Urol Oncol 2019; 37:179.e1-179.e7. [DOI: 10.1016/j.urolonc.2018.10.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 10/05/2018] [Accepted: 10/06/2018] [Indexed: 10/27/2022]
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Audenet F, Attalla K, Giordano M, Pfail J, Lubin MA, Waingankar N, Gainsburg D, Badani KK, Sim A, Sfakianos JP. Prospective implementation of a nonopioid protocol for patients undergoing robot-assisted radical cystectomy with extracorporeal urinary diversion. Urol Oncol 2019; 37:300.e17-300.e23. [PMID: 30777392 DOI: 10.1016/j.urolonc.2019.02.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 12/14/2018] [Accepted: 02/05/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To evaluate the feasibility and outcomes of a nonopioid (NOP) perioperative pain management protocol for patients undergoing robot-assisted radical cystectomy (RARC). MATERIALS AND METHODS We prospectively included 52 consecutive patients undergoing RARC at our institution for bladder cancer. Patients received a multimodal pain management protocol, including a combination of nonopioid pain medications and regional anesthesia. For comparison, we retrospectively included 41 consecutive patients who received the same procedure before implementation of the NOP protocol. RESULTS There was no significant difference in demographic and perioperative characteristics between the two groups. Patients included in the NOP protocol received a much lower dose of postoperative morphine milligram equivalents (2.5 [IQR: 0-23] vs. 44 [14.5-128], P < 0.001), with no difference in pain scores. In the NOP protocol, the median time to regular diet was significantly shorter (4days [IQR: 3-5] vs. 5days [IQR: 4-8], P = 0.002) and the length of stay was 2days shorter compared to the control group (5days [IQR: 4-7] vs. 7days [IQR: 6-11], P < 0.001). When evaluating the direct costs within 30days after initial surgery, the NOP protocol was associated with an 8.6% reduction as compared to the control group (P = 0.032). In multivariate analysis, the receipt of the NOP protocol was a significant predictor of a length of stay <7days after RARC (OR: 12.09; 95% CI: 1.70-140; P = 0.023). CONCLUSIONS The prospective implementation of a NOP protocol for patients undergoing RARC is feasible, allowing for minimal narcotic usage and provides benefits to patients, institutions, and population.
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Affiliation(s)
- François Audenet
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kyrollis Attalla
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Morgane Giordano
- Department of Anesthesia, Perioperative and Pain Medicine, Icahn school of Medicine at Mount Sinai, New York, NY
| | - John Pfail
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Marc A Lubin
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Nikhil Waingankar
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Daniel Gainsburg
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY; Department of Anesthesia, Perioperative and Pain Medicine, Icahn school of Medicine at Mount Sinai, New York, NY
| | - Ketan K Badani
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alan Sim
- Department of Anesthesia, Perioperative and Pain Medicine, Icahn school of Medicine at Mount Sinai, New York, NY
| | - John P Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.
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Teishima J, Matsubara A. Editorial Comment to Utility of robot-assisted radical cystectomy with intracorporeal urinary diversion for muscle-invasive bladder cancer. Int J Urol 2019; 26:340-341. [PMID: 30690810 DOI: 10.1111/iju.13906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Jun Teishima
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akio Matsubara
- Department of Urology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
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Soria F, Moschini M, D'andrea D, Abufaraj M, Foerster B, Mathiéu R, Gust KM, Gontero P, Simone G, Meraney A, Krishna S, Konety B, Rouprêt M, Perry M, Rowe E, Ploussard G, Boorjian SA, Wiklund P, Sooriakumaran P, Shariat SF. Comparative Effectiveness in Perioperative Outcomes of Robotic versus Open Radical Cystectomy: Results from a Multicenter Contemporary Retrospective Cohort Study. Eur Urol Focus 2018; 6:1233-1239. [PMID: 30455153 DOI: 10.1016/j.euf.2018.11.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 10/20/2018] [Accepted: 11/07/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND The comparative effectiveness of robotic-assisted radical cystectomy (RARC) versus open radical cystectomy (ORC) in terms of perioperative outcomes is still a matter of debate affecting payors, physicians, and patients. OBJECTIVE To evaluate comparative perioperative and longer-term morbidity of RARC versus ORC in a multicenter contemporary retrospective cohort of patients. DESIGN, SETTING, AND PARTICIPANTS This retrospective multicenter study included patients with bladder cancer treated with radical cystectomy at 10 academic centers between 2000 and 2017. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Intraoperative outcomes including blood loss and operative time as well as postoperative outcomes including time to discharge, complication, readmission, reoperation, and mortality rates at 30 and 90 d were assessed. Multiple imputation and inverse probability of treatment weighting (IPTW) were used. IPTW-multivariable-adjusted regression and logistic analyses were performed to evaluate the associations of RARC versus ORC with perioperative outcomes at 30 and 90 d. RESULTS AND LIMITATIONS Overall, 1887 patients (1197 RARC and 690 ORC) were included in the study. After IPTW-adjusted analysis, no differences between the groups in terms of preoperative characteristics were observed. RARC was associated with lower blood loss (p<0.001), shorter length of stay (p<0.001), and longer operative time (p=0.007). On IPTW-adjusted multivariable logistic regression analyses, no differences in terms of 30- and 90-d complications, reoperation, and mortality rates were observed. RARC was independently associated with a higher readmission rate at both 30 and 90 d. Limitations are mainly related to the retrospective nature of the study. CONCLUSIONS While RARC was associated with less blood loss and shorter hospital stay, it also led to longer operation times and more readmissions. There were no differences in 30- and 90-d complications. Because there are no apparent differences in safety between ORC and RARC in expert centers, differences in oncologic and cost-effectiveness outcomes are likely to drive decision making regarding RARC utilization. PATIENT SUMMARY In this study we investigated the differences between RARC and ORC in terms of perioperative outcomes. We found no difference in early and late complications. We concluded that, to date, differences in oncologic and cost-effectiveness outcomes should drive decision making regarding RARC utilization.
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Affiliation(s)
- Francesco Soria
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Marco Moschini
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy; Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland
| | - David D'andrea
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Mohammad Abufaraj
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan
| | - Beat Foerster
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Romain Mathiéu
- Department of Urology, Rennes University Hospital, Rennes, France
| | - Killian M Gust
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria
| | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy
| | - Giuseppe Simone
- "Regina Elena" National Cancer Institute, Department of Urology, Rome, Italy
| | - Anoop Meraney
- Urology Division, Hartford Healthcare Medical Group, Hartford, CT, USA
| | - Suprita Krishna
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Badrinath Konety
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Morgan Rouprêt
- Sorbonne Université, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Matthew Perry
- Department of Urology, St George's Hospital, London, UK
| | - Edward Rowe
- Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | | | | | - Peter Wiklund
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Prasanna Sooriakumaran
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Department of Uro-oncology, University College London Hospital NHS Foundation Trust, London, UK
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Rossanese M, Subba E, Giannarini G, Inferrera A, Ficarra V. Open radical cystectomy: lessons from the British Association of Urological Surgeons (BAUS) registry. Transl Androl Urol 2018; 7:745-748. [PMID: 30211067 PMCID: PMC6127551 DOI: 10.21037/tau.2018.06.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Marta Rossanese
- Department of Human and Paediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Messina, Italy
| | - Enrica Subba
- Department of Human and Paediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Messina, Italy
| | - Gianluca Giannarini
- Urology Unit, Academic Medical Centre "Santa Maria della Misericordia", Udine, Italy
| | - Antonino Inferrera
- Department of Human and Paediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Messina, Italy
| | - Vincenzo Ficarra
- Department of Human and Paediatric Pathology "Gaetano Barresi", Urologic Section, University of Messina, Messina, Italy
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