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Long-term oncologic outcomes of robot-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion (ICUD): a multi-center study

  • Aldo BrassettiEmail author
  • Giovanni Cacciamani
  • Umberto Anceschi
  • Mariaconsiglia Ferriero
  • Gabriele Tuderti
  • Gus Miranda
  • Riccardo Mastroianni
  • Mihir Desai
  • Monish Aron
  • Inderbir Gill
  • Michele Gallucci
  • Giuseppe Simone
Topic Paper

Abstract

Purpose

To report survival outcomes after robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) for recurrent/muscle-invasive non-metastatic bladder cancer.

Methods

Prospectively maintained databases were queried for “robotic cystectomy AND ICUD”. Patients treated after October 2013 and those treated without curative intent were excluded. Kaplan–Meier method was used to plot stage-specific survival outcomes, computed at 1, 2, and 5 years after surgery. Univariable and multivariable Cox analyses assessed predictors of recurrence-free (RFS), cancer-specific (CSS) and overall (OS) survival.

Results

113 consecutive patients were included, mostly men (82%). Neoadjuvant chemotherapy was performed in 23% of cases, median lymph node (LN) yield was 36 (IQR 28–45) and the rate of positive surgical margins (PSM) was 8%. Orthotopic ileal neobladder was the preferred ICUD type (57%). An organ-confined disease was observed in 51% of cases and 21% were pT0 on final histology. Overall, 5-year RFS, CSS and OS probabilities were 58 ± 5%, 61 ± 5% and 54 ± 5%, respectively. At Kaplan–Meier method, tumor stage group was a significant predictor of survival probabilities (all p < 0.001) and this was confirmed at multivariable Cox regression analysis (RFS-OR 2.29; 95% CI 1.58–3.32; p < 0.001) (CSS-OR 1.82; 95% CI 1.3–2.53; p < 0.001) (OS-OR 2.14; 95% CI 1.46–3.14; p < 0.001). PSM status was associated to CSS (OR 2.54; 95% CI 1.13–5.69; p = 0.024) and OS (OR 2.82; 95% CI 1.17–6.77; p = 0.021), but did not predict RFS (p = 0.062).

Conclusions

Long-term oncologic outcomes after RARC with ICUD appear similar to recent robotic series with extracorporeal diversion and historical open experiences.

Keywords

Bladder cancer Long-term outcomes Radical cystectomy Robotic Survival Urothelial carcinoma 

Notes

Author contributions

UA: data collection, project development, and critical revision. MA: project development and critical revision. AB: project development, data analysis, manuscript writing, and submission. GC: project development and critical revision. MD: project development and critical revision. MCF: project development and critical revision. MG: project development and critical revision. IG: project development and critical revision. RM: data collection and project development. GM: project development and critical revision. GT: data collection, project development, and critical revision. GS: protocol development, project development, critical revision, supervision, and administrative.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Review board approval was obtained for this retrospective study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of UrologyIRCCS “Regina Elena” National Cancer InstituteRomeItaly
  2. 2.Department of UrologyUniversity of Southern CaliforniaLos AngelesUSA
  3. 3.Department of Urology“Sapienza” University of RomeRomeItaly

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