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01-04-2020 | Cystectomy | Topic Paper

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

Authors: Aldo Brassetti, Giovanni Cacciamani, Umberto Anceschi, Mariaconsiglia Ferriero, Gabriele Tuderti, Gus Miranda, Riccardo Mastroianni, Mihir Desai, Monish Aron, Inderbir Gill, Michele Gallucci, Giuseppe Simone

Published in: World Journal of Urology | Issue 4/2020

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.

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Title: Long-term oncologic outcomes of robot-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion (ICUD): a multi-center study
Authors: Aldo Brassetti
Giovanni Cacciamani
Umberto Anceschi
Mariaconsiglia Ferriero
Gabriele Tuderti
Gus Miranda
Riccardo Mastroianni
Mihir Desai
Monish Aron
Inderbir Gill
Michele Gallucci
Giuseppe Simone
Publication date: 01-04-2020
Publisher: Springer Berlin Heidelberg
Keywords: Cystectomy
Urothelial Cancer
Urothelial Cancer
Published in: World Journal of Urology / Issue 4/2020
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-019-02842-3

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

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

Abstract

Purpose

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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