Oncologic Equipoise between Robotic and Open Radical Cystectomy

Janet Baack Kukreja, Roger Li, Vikram M. Narayan, Amy Lim, Mohamed Seif, Xuemei Wang, Ashish Kamat, Colin DInney, Neema Navai

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Our objective was to establish the incidence of positive surgical margins, recurrence patterns, and recurrence-free (RFS) and overall survival (OS) in a large cohort of patients undergoing robotic (robot-assisted radical cystectomy [RARC]) and open radical cystectomy (ORC). Materials and Methods: We performed a large retrospective cohort study at a high-volume academic tertiary referral center. Patients were those who underwent RC for bladder cancer from 2005 to 2017. Patients were allocated to ORC or RARC by patient and surgeon choice. Propensity matching and a multivariable analysis were performed to determine factors predictive of RFS and OS after RC. All analyses were done with SAS 9.4. Results: The study included 1885 patients, 13.5% of whom underwent RARC. There was no difference in positive soft tissue surgical margins (2.4% in ORC and 1.2% in RARC). There were no differences in recurrence patterns, nor in the severity of pathology distribution between the two cohorts. Peritoneal carcinomatosis was seen in 1.1% of ORC and 0.8% in RARC. Shorter RFS was associated with younger age (hazard ratio [HR] 1.04, 95% confidence interval [CI] 1.03-1.05, p < 0.001), neoadjuvant chemotherapy (HR 1.41, 95% CI 1.14-1.75, p = 0.002), higher pathologic stage (stage ≥T2 HR 2.45, 95% CI 1.91-3.16, p < 0.001), lymph node positivity at cystectomy (HR 1.92, 95% CI 1.50-2.47, p < 0.001), and positive surgical margins (HR 1.49, 95% CI 1.09-2.05, p = 0.01). RFS and OS did not differ by surgical approach (HR 1.04, 95% CI 0.83-1.30), p = 0.75 and (HR 0.89, 95% CI 0.67-1.19), p = 0.43, respectively. Conclusion: The data from this study support continued use of RARC as a safe oncologic procedure, with similar outcomes to ORC.

Original languageEnglish (US)
Pages (from-to)1168-1176
Number of pages9
JournalJournal of Endourology
Volume35
Issue number8
DOIs
StatePublished - Aug 2021

Keywords

  • bladder cancer
  • cystectomy
  • robot-assisted laparoscopic surgery

ASJC Scopus subject areas

  • Urology

MD Anderson CCSG core facilities

  • Biostatistics Resource Group

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