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Oncological outcomes of totally intracorporeal robot-assisted radical cystectomy: Results from the European Association of Urology Robotic Urology Section (ERUS) scientific working group
PE14 Oncological outcomes of totally intracorporeal robot-assisted radical cystectomy: Results from the European Association of Urology Robotic Urology Section (ERUS) scientific working group Hosseini A.1, Collins J.W.1, Adding C.1, Nyberg T.2, Koupparis A.3, Rowe E.3, Perry M.4, Issa R.4, Schumacher M.5, Wijburg C.6, Canda A.E.7, Balbay M.8, Decaestecker K.9, Schwentner C.10, Stenzl A.10, Edeling S.11, Pokupić S.11, D'hondt F.12, Mottrie A.12, Wiklund N.P.1 1
Karolinska University Hospital, Dept. of Urology, Stockholm, Sweden, 2Karolinska Institutet, Dept. of Clinical Cancer Edpidemiology, Stockholm, Sweden, 3Bristol Urological Institute, Dept. of Urology, Bristol, United Kingdom, 4St Georges, Dept. of Urology, London, United Kingdom, 5Hirslanden Klinik, Dept. of Urology, Aarau, Switzerland, 6Rijnstate, Dept. of Urology, Arnhem, The Netherlands, 7Ankara Ataturk Hospital, Dept. of Urology, Ankara, Turkey, 8Memorial Sisli Hospital, Dept. of Urology, Istanbul, Turkey, 9Ghent University Hospital, Dept. of Urology, Ghent, Belgium, 10University of Tuebingen, Dept. of Urology, Tuebingen, Germany, 11Da Vinci Zentrum, Dept. of Urology, Hanover, Germany, 12O.L.V, Dept. of Urology, Aalst, Belgium INTRODUCTION & 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. MATERIAL & METHODS: Retrospective review of the prospectively populated ERUS scientific working group multiinstitutional database identified 719 patients at 9 different Institutions (6 countries), with a minimum of 12 months followup, who underwent RARC with an intracorporeal urinary diversion between December 2003 and March 2015. Clinical, pathologic, and survival data at the latest follow-up were collected. RESULTS: Median age was 68 years, 78% were men. 95% of patients had transitional cell carcinoma. 532 (74%) patients were alive at the time of the analysis. 25% received neoadjuvant chemotherapy. The median follow-up time for patients was 31 months (IQR 20-46). 291 patients (40%) had a minimum of 3 years follow-up and 98 patients (14%) had undergone surgery 5 or more years ago. 35 patients (5.3%) had a positive surgical margin (PSM), of which 93.5% had T3/T4 disease, equivalent to 14.1% of all patients with T3/T4. Two patients (0.7%) with organ-confined disease had a PSM. The median yield for extended pelvic lymph node dissection was 18. The 5-year cancer specific survival (CSS), overall survival (OS) and recurrence free survival (RFS) were 70.0%, 65.7% and 66.3% respectively. On multivariable analysis, non-organ confined versus organ confined disease was found to impact CSS, OS and RFS (HR 2.8, 2.5 and 2.8 respectively). Positive compared to negative lymph nodes also negatively impacted CSS, (pN1 vs pN0 HR=2.595 and pN2 vs pN0 HR=2.821), OS (pN1 vs pN0 HR=2.212 and pN2 vs pN0 HR=2.540) and RFS (pN1 vs pN0 HR=2.295 and pN2 vs pN0 HR=3.800). PSM effected CSS (HR=1.758) and female sex negatively impacted RFS (HR=1.540). CONCLUSIONS: Oncological follow-up for totally intracorporeal RARC shows acceptable survival outcomes comparable to open radical cystectomy series.
Eur Urol Suppl 2016; 15(7):232
Karolinska University Hospital, Dept. of Urology, Stockholm, Sweden, 2Karolinska Institutet, Dept. of Clinical Cancer Edpidemiology, Stockholm, Sweden, 3Bristol Urological Institute, Dept. of Urology, Bristol, United Kingdom, 4St Georges, Dept. of Urology, London, United Kingdom, 5Hirslanden Klinik, Dept. of Urology, Aarau, Switzerland, 6Rijnstate, Dept. of Urology, Arnhem, The Netherlands, 7Ankara Ataturk Hospital, Dept. of Urology, Ankara, Turkey, 8Memorial Sisli Hospital, Dept. of Urology, Istanbul, Turkey, 9Ghent University Hospital, Dept. of Urology, Ghent, Belgium, 10University of Tuebingen, Dept. of Urology, Tuebingen, Germany, 11Da Vinci Zentrum, Dept. of Urology, Hanover, Germany, 12O.L.V, Dept. of Urology, Aalst, Belgium INTRODUCTION & 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. MATERIAL & METHODS: Retrospective review of the prospectively populated ERUS scientific working group multiinstitutional database identified 719 patients at 9 different Institutions (6 countries), with a minimum of 12 months followup, who underwent RARC with an intracorporeal urinary diversion between December 2003 and March 2015. Clinical, pathologic, and survival data at the latest follow-up were collected. RESULTS: Median age was 68 years, 78% were men. 95% of patients had transitional cell carcinoma. 532 (74%) patients were alive at the time of the analysis. 25% received neoadjuvant chemotherapy. The median follow-up time for patients was 31 months (IQR 20-46). 291 patients (40%) had a minimum of 3 years follow-up and 98 patients (14%) had undergone surgery 5 or more years ago. 35 patients (5.3%) had a positive surgical margin (PSM), of which 93.5% had T3/T4 disease, equivalent to 14.1% of all patients with T3/T4. Two patients (0.7%) with organ-confined disease had a PSM. The median yield for extended pelvic lymph node dissection was 18. The 5-year cancer specific survival (CSS), overall survival (OS) and recurrence free survival (RFS) were 70.0%, 65.7% and 66.3% respectively. On multivariable analysis, non-organ confined versus organ confined disease was found to impact CSS, OS and RFS (HR 2.8, 2.5 and 2.8 respectively). Positive compared to negative lymph nodes also negatively impacted CSS, (pN1 vs pN0 HR=2.595 and pN2 vs pN0 HR=2.821), OS (pN1 vs pN0 HR=2.212 and pN2 vs pN0 HR=2.540) and RFS (pN1 vs pN0 HR=2.295 and pN2 vs pN0 HR=3.800). PSM effected CSS (HR=1.758) and female sex negatively impacted RFS (HR=1.540). CONCLUSIONS: Oncological follow-up for totally intracorporeal RARC shows acceptable survival outcomes comparable to open radical cystectomy series.
Eur Urol Suppl 2016; 15(7):232