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MP67-19 ONCOLOGICAL OUTCOMES OF TOTALLY INTRACORPOREAL ROBOT-ASSISTED RADICAL CYSTECTOMY: RESULTS FROM THE ERUS SCIENTIFIC WORKING GROUP.
THE JOURNAL OF UROLOGYâ
Vol. 193, No. 4S, Supplement, Monday, May 18, 2015
e857
(0.8%). Final pathologic stage was T2 in 62.8% of cases and 57 patients (22.4%) had lymph node positive disease. Overall and diseasespecific survival were significantly worse in patients with pT3/4 disease and positive lymph nodes. (Figure 1). CONCLUSIONS: Robotic cystectomy is a viable, potentially firstline, treatment option for high-risk bladder cancer. Our surgical and oncological outcomes compare well with the largest published open series.
Source of Funding: None
Source of Funding: none
MP67-19 ONCOLOGICAL OUTCOMES OF TOTALLY INTRACORPOREAL ROBOT-ASSISTED RADICAL CYSTECTOMY: RESULTS FROM THE ERUS SCIENTIFIC WORKING GROUP. Justin Collins*, Abolfazl Hosseini, Stockholm, Sweden; Martin Schumacher, Aarau, Switzerland; Abdullah Canda, Ankara, Turkey; Carl Wijburg, Arnhem, Netherlands; Christian Schwentner, Arnulf Stenzl, Tubingen, Germany; Derya Balbay, Istanbul, Turkey; Karel Decaestecker, Ghent, Belgium; Sebastian Edeling, Sasa Pokupic, Hannover, Germany; Khurshid Guru, Buffalo, NY; Alexander Mottrie, Aalst, Belgium; Peter Wiklund, Stockholm, Sweden INTRODUCTION AND OBJECTIVES: Data on the oncological outcomes in patients undergoing robot-assisted radical cystectomy (RARC) is limited. Globally extracorporeal urinary diversion following RARC remains the most common approach despite potential advantages of a completely minimally invasive approach. We report oncological outcomes and associated prognostic factors from a multi-institutional European database focusing on the centres performing totally intracorporeal RARC. METHODS: In the ERUS scientific working group database, 467 patients underwent totally intracorporeal RARC for bladder cancer between 2003 and 2014. Clinical and pathological data at the time of the latest follow-up was reviewed. Recurrence free survival (RFS), cancer specific survival (CSS) and overall survival (OS) were the outcomes of interest and evaluated using the Kaplan Meier estimator. Multivariable Cox regression analysis was performed to identify factors associated with outcomes of interest. RESULTS: Mean age was 67 years, 80% were men. 384 (82%) patients were alive at the time of the analysis. Median follow-up was 17.9 months (range 1-130 months). 87 patients (19%) had undergone surgery 3 or more years’ ago. Median follow-up of patients alive was 16 months. 31% patients had pathological non organ-confined disease. Positive surgical margins were present in 5%; median lymph node yield was 18 with 19% of patients having positive lymph nodes. The 3-year RFS, CSS and OS were 73%, 75% and 73% respectively. On multivariable analysis, non-organ confined disease was found to impact RFS, CSS and OS (HR 4.0, 4.3 and 4.2 respectively) and LN positive disease was associated with poorer RFS (HR 2.1). Histopathology stage pT0 was a positive prognostic indicator associated with better RFS, CSS and OS (HR 0.15, 0.16 and 0.74 respectively). CONCLUSIONS: This is the largest reported multi-institutional cohort of totally intracorporeal RARC showing acceptable medium term survival outcomes comparable to open radical cystectomy series. The ERUS scientific working group database indicates that a totally intracorporeal approach is replicable.
MP67-20 QUALITY OF LIFE ASSESSMENT WITH ORTHOTOPIC ILEAL NEOBLADDER RECONSTRUCTION AFTER RADICAL CYSTECTOMY: RESULTS FROM A PROSPECTIVE ITALIAN MULTICENTER OBSERVATIONAL STUDY Paolo Verze*, Ciro Imbimbo, Vincenzo Mirone, Naples, Italy; Salvatore Siracusano, Trieste, Italy; Mauro Niero, Maria Angela Cerruto, Cristina Lonardi, Walter Artibani, Verona, Italy; Pierfrancesco Bassi, Rome, Italy; Massimo Iafrate, Padova, Italy; Marco Racioppi, Rome, Italy; Renato Talamini, Stefano Ciciliato, Laura Toffoli, Francesco Visalli, Trieste, Italy; Davide Massidda, Carolina D’elia, Giovanni Cacciamani, Davide De Marchi, Verona, Italy; Tommaso Silvestri, Trieste, Italy; Massimiliano Creta, Naples, Italy; Emanuele Belgrano, Trieste, Italy INTRODUCTION AND OBJECTIVES: Purpose of the study is to assess through generic and IONB-specific questionnaires HRQoL in BCa patients who received RC with IONB reconstruction. METHODS: we performed a multicenter, cross-sectional analysis of 171 RC-IONB patients. Patients completed the following questionnaires: the European Organisation for Research and Treatment of Cancer (EORTC) generic (QLQ-C30) and bladder cancer-specific instruments (QLQ-BLM30) and the IONBePatient Reported Outcome (IONB ePRO) questionnaire. Linear/Logistic regression models tested the association between clinic-pathological variables and HRQOL domain scores and the presence of independent predictors of local recurrence and urinary incontinence. RESULTS: Mean age was 60.04 and 156/171 (91.2%) were male patients. Mean follow-up period was 51.72 months. Most frequently reported concomitant medical conditions were: grade I renal impairment, grade I cardiac insufficiency, hypertension. Increasing age (p <0.006) and urinary incontinence (p <0.003) resulted significantly related to a deteriorating overall quality of life. Sex (OR¼0.167, p¼0.012), presence of hypertension at baseline (OR¼3.464, p¼0.001) and age (OR¼1.046, p 0.016) were independent predictors of urinary incontinence while sex (OR¼0.051, p¼0.046), BMI (OR¼0.543, p¼0.001), presence of renal impairment at baseline (OR¼0.009, p<0.001), and presence of peripheral vascular disease at baseline (OR¼0.044, p¼0.003) resulted independent predictors of disease recurrence. CONCLUSIONS: Our analysis shows that post-RC IONB patients have a mild to moderate impairment of their HRQoL when investigated by means of generic and disease specific instruments and a more pronounced impairment when investigated with the IONB-PRO specific instrument. Age, comorbidities and post-operative pathologic factors may influence HRQoL and should be considered in pre- and post-operative counseling. Source of Funding: none
Vol. 193, No. 4S, Supplement, Monday, May 18, 2015
e857
(0.8%). Final pathologic stage was T2 in 62.8% of cases and 57 patients (22.4%) had lymph node positive disease. Overall and diseasespecific survival were significantly worse in patients with pT3/4 disease and positive lymph nodes. (Figure 1). CONCLUSIONS: Robotic cystectomy is a viable, potentially firstline, treatment option for high-risk bladder cancer. Our surgical and oncological outcomes compare well with the largest published open series.
Source of Funding: None
Source of Funding: none
MP67-19 ONCOLOGICAL OUTCOMES OF TOTALLY INTRACORPOREAL ROBOT-ASSISTED RADICAL CYSTECTOMY: RESULTS FROM THE ERUS SCIENTIFIC WORKING GROUP. Justin Collins*, Abolfazl Hosseini, Stockholm, Sweden; Martin Schumacher, Aarau, Switzerland; Abdullah Canda, Ankara, Turkey; Carl Wijburg, Arnhem, Netherlands; Christian Schwentner, Arnulf Stenzl, Tubingen, Germany; Derya Balbay, Istanbul, Turkey; Karel Decaestecker, Ghent, Belgium; Sebastian Edeling, Sasa Pokupic, Hannover, Germany; Khurshid Guru, Buffalo, NY; Alexander Mottrie, Aalst, Belgium; Peter Wiklund, Stockholm, Sweden INTRODUCTION AND OBJECTIVES: Data on the oncological outcomes in patients undergoing robot-assisted radical cystectomy (RARC) is limited. Globally extracorporeal urinary diversion following RARC remains the most common approach despite potential advantages of a completely minimally invasive approach. We report oncological outcomes and associated prognostic factors from a multi-institutional European database focusing on the centres performing totally intracorporeal RARC. METHODS: In the ERUS scientific working group database, 467 patients underwent totally intracorporeal RARC for bladder cancer between 2003 and 2014. Clinical and pathological data at the time of the latest follow-up was reviewed. Recurrence free survival (RFS), cancer specific survival (CSS) and overall survival (OS) were the outcomes of interest and evaluated using the Kaplan Meier estimator. Multivariable Cox regression analysis was performed to identify factors associated with outcomes of interest. RESULTS: Mean age was 67 years, 80% were men. 384 (82%) patients were alive at the time of the analysis. Median follow-up was 17.9 months (range 1-130 months). 87 patients (19%) had undergone surgery 3 or more years’ ago. Median follow-up of patients alive was 16 months. 31% patients had pathological non organ-confined disease. Positive surgical margins were present in 5%; median lymph node yield was 18 with 19% of patients having positive lymph nodes. The 3-year RFS, CSS and OS were 73%, 75% and 73% respectively. On multivariable analysis, non-organ confined disease was found to impact RFS, CSS and OS (HR 4.0, 4.3 and 4.2 respectively) and LN positive disease was associated with poorer RFS (HR 2.1). Histopathology stage pT0 was a positive prognostic indicator associated with better RFS, CSS and OS (HR 0.15, 0.16 and 0.74 respectively). CONCLUSIONS: This is the largest reported multi-institutional cohort of totally intracorporeal RARC showing acceptable medium term survival outcomes comparable to open radical cystectomy series. The ERUS scientific working group database indicates that a totally intracorporeal approach is replicable.
MP67-20 QUALITY OF LIFE ASSESSMENT WITH ORTHOTOPIC ILEAL NEOBLADDER RECONSTRUCTION AFTER RADICAL CYSTECTOMY: RESULTS FROM A PROSPECTIVE ITALIAN MULTICENTER OBSERVATIONAL STUDY Paolo Verze*, Ciro Imbimbo, Vincenzo Mirone, Naples, Italy; Salvatore Siracusano, Trieste, Italy; Mauro Niero, Maria Angela Cerruto, Cristina Lonardi, Walter Artibani, Verona, Italy; Pierfrancesco Bassi, Rome, Italy; Massimo Iafrate, Padova, Italy; Marco Racioppi, Rome, Italy; Renato Talamini, Stefano Ciciliato, Laura Toffoli, Francesco Visalli, Trieste, Italy; Davide Massidda, Carolina D’elia, Giovanni Cacciamani, Davide De Marchi, Verona, Italy; Tommaso Silvestri, Trieste, Italy; Massimiliano Creta, Naples, Italy; Emanuele Belgrano, Trieste, Italy INTRODUCTION AND OBJECTIVES: Purpose of the study is to assess through generic and IONB-specific questionnaires HRQoL in BCa patients who received RC with IONB reconstruction. METHODS: we performed a multicenter, cross-sectional analysis of 171 RC-IONB patients. Patients completed the following questionnaires: the European Organisation for Research and Treatment of Cancer (EORTC) generic (QLQ-C30) and bladder cancer-specific instruments (QLQ-BLM30) and the IONBePatient Reported Outcome (IONB ePRO) questionnaire. Linear/Logistic regression models tested the association between clinic-pathological variables and HRQOL domain scores and the presence of independent predictors of local recurrence and urinary incontinence. RESULTS: Mean age was 60.04 and 156/171 (91.2%) were male patients. Mean follow-up period was 51.72 months. Most frequently reported concomitant medical conditions were: grade I renal impairment, grade I cardiac insufficiency, hypertension. Increasing age (p <0.006) and urinary incontinence (p <0.003) resulted significantly related to a deteriorating overall quality of life. Sex (OR¼0.167, p¼0.012), presence of hypertension at baseline (OR¼3.464, p¼0.001) and age (OR¼1.046, p 0.016) were independent predictors of urinary incontinence while sex (OR¼0.051, p¼0.046), BMI (OR¼0.543, p¼0.001), presence of renal impairment at baseline (OR¼0.009, p<0.001), and presence of peripheral vascular disease at baseline (OR¼0.044, p¼0.003) resulted independent predictors of disease recurrence. CONCLUSIONS: Our analysis shows that post-RC IONB patients have a mild to moderate impairment of their HRQoL when investigated by means of generic and disease specific instruments and a more pronounced impairment when investigated with the IONB-PRO specific instrument. Age, comorbidities and post-operative pathologic factors may influence HRQoL and should be considered in pre- and post-operative counseling. Source of Funding: none