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Robotic versus open radical cystectomy throughout the learning phase: insights from a real-life multicenter study

  • Louis Lenfant
  • Riccardo Campi
  • Jérôme Parra
  • Vivien Graffeille
  • Alexandra Masson-Lecomte
  • Dimitri Vordos
  • Alexandre de La Taille
  • Mathieu Roumiguie
  • Marine Lesourd
  • Lionel Taksin
  • Vincent Misraï
  • Benjamin Granger
  • Guillaume Ploussard
  • Christophe Vaessen
  • Gregory Verhoest
  • Morgan RouprêtEmail author
Original Article
  • 26 Downloads

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.

Keywords

Cystectomy Urinary bladder neoplasms Robotic surgical procedures Postoperative complications Comparative effectiveness research 

Notes

Author contributions

LL: protocol/project development, data collection or management, data analysis, and manuscript writing/editing. RC: data analysis, and manuscript writing/editing. JP: protocol/project development. VG: data collection or management. AM-L: data collection or management. DV: data collection or management. ALT: protocol/project development. MR: protocol/project development. ML: data collection or management. LT: data collection or management. VM: data collection or management. BG: data analysis. GP: protocol/project development, and data collection or management. CV: protocol/project development. GV: protocol/project development, and manuscript writing/editing. MR: protocol/project development, and manuscript writing/editing.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Human and animal rights

Formal consent is not required for retrospective study.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

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

Authors and Affiliations

  • Louis Lenfant
    • 1
  • Riccardo Campi
    • 1
    • 2
  • Jérôme Parra
    • 1
  • Vivien Graffeille
    • 3
  • Alexandra Masson-Lecomte
    • 4
  • Dimitri Vordos
    • 4
  • Alexandre de La Taille
    • 4
  • Mathieu Roumiguie
    • 5
  • Marine Lesourd
    • 5
  • Lionel Taksin
    • 6
  • Vincent Misraï
    • 7
  • Benjamin Granger
    • 8
  • Guillaume Ploussard
    • 9
  • Christophe Vaessen
    • 1
  • Gregory Verhoest
    • 3
  • Morgan Rouprêt
    • 1
    Email author
  1. 1.Sorbonne University, Hopital Pitié Salpétrière, UrologyAssistance Publique-Hôpitaux de Paris (AP-HP)ParisFrance
  2. 2.Department of Urology, Careggi HospitalUniversity of FlorenceFlorenceItaly
  3. 3.Department of UrologyPontchaillou Hospital, CHU RENNESRennesFrance
  4. 4.Department of Urology, Henri Mondor HospitalAssistance Publique-Hôpitaux de Paris (AP-HP) CHU Mondor, Faculté de MédecineCréteilFrance
  5. 5.Department of Urology, Andrology and Renal TransplantationCHU Rangueil, Paul-Sabatier UniversityToulouse CedexFrance
  6. 6.Hôpital privé d’AntonyAntonyFrance
  7. 7.Clinique PasteurToulouseFrance
  8. 8.Department of Biostatistics, Groupe Hospitalo-Universitaire EST, Faculté de Médecine Pierre et Marie Curie, Pitié-Salpétrière HospitalAssistance Publique-Hôpitaux de Paris (AP-HP), University Paris SorbonneParisFrance
  9. 9.Department of UrologyClinique St Jean du LanguedocToulouseFrance

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