TY - JOUR
T1 - Intra-corporeal robot-assisted versus open radical cystectomy
T2 - a propensity score-matched analysis comparing perioperative and long-term survival outcomes and recurrence patterns
AU - Zennami, Kenji
AU - Sumitomo, Makoto
AU - Takahara, Kiyoshi
AU - Nukaya, Takuhisa
AU - Takenaka, Masashi
AU - Fukaya, Kosuke
AU - Ichino, Manabu
AU - Fukami, Naohiko
AU - Sasaki, Hitomi
AU - Kusaka, Mamoru
AU - Shiroki, Ryoichi
N1 - Publisher Copyright:
© 2021, Japan Society of Clinical Oncology.
PY - 2021/8
Y1 - 2021/8
N2 - Background: To compare perioperative and long-term oncological outcomes and recurrence patterns between robot-assisted radical cystectomy with intra-corporeal urinary diversion (iRARC) and open radical cystectomy (ORC). Methods: We retrospectively analyzed 177 bladder cancer patients who received iRARC or ORC at Fujita Health University between 2008 and 2020. Our primary endpoint was long-term oncological outcomes. As a secondary endpoint, we examined perioperative outcomes, complications, and recurrence patterns. These outcome measures were compared between the propensity score (PS)-matched cohorts. Results: PS-matched analysis resulted in 60 matched pairs from iRARC and ORC groups. The iRARC cohort was associated with significantly longer operative time (p = 0.02), lower estimated blood loss (p < 0.001), lower blood transfusion rate (p < 0.001), shorter length of hospital stay (p < 0.001), fewer overall complications (p = 0.03), and lower rate of postoperative ileus (p = 0.02). There was no statistically significant difference between iRARC and ORC in 5-year RFS (p = 0.46), CSS (p = 0.63), and OS (p = 0.71). RFS and CSS were also comparable, even in locally advanced (≥ cT3) disease. Multivariate analysis identified lymphovascular invasion as a robust predictor of RFS, CSS, and OS. The number of recurrence was similar between the groups, while extra-pelvic lymph nodes were more frequent in iRARC than that in ORC (22.7% vs. 7.7%). Conclusions: iRARC has favorable perioperative outcomes, fewer complications, and comparable long-term survival outcomes, including locally advanced (≥ cT3) disease, compared to that in ORC. Our results need to be validated in prospective randomized clinical trials.
AB - Background: To compare perioperative and long-term oncological outcomes and recurrence patterns between robot-assisted radical cystectomy with intra-corporeal urinary diversion (iRARC) and open radical cystectomy (ORC). Methods: We retrospectively analyzed 177 bladder cancer patients who received iRARC or ORC at Fujita Health University between 2008 and 2020. Our primary endpoint was long-term oncological outcomes. As a secondary endpoint, we examined perioperative outcomes, complications, and recurrence patterns. These outcome measures were compared between the propensity score (PS)-matched cohorts. Results: PS-matched analysis resulted in 60 matched pairs from iRARC and ORC groups. The iRARC cohort was associated with significantly longer operative time (p = 0.02), lower estimated blood loss (p < 0.001), lower blood transfusion rate (p < 0.001), shorter length of hospital stay (p < 0.001), fewer overall complications (p = 0.03), and lower rate of postoperative ileus (p = 0.02). There was no statistically significant difference between iRARC and ORC in 5-year RFS (p = 0.46), CSS (p = 0.63), and OS (p = 0.71). RFS and CSS were also comparable, even in locally advanced (≥ cT3) disease. Multivariate analysis identified lymphovascular invasion as a robust predictor of RFS, CSS, and OS. The number of recurrence was similar between the groups, while extra-pelvic lymph nodes were more frequent in iRARC than that in ORC (22.7% vs. 7.7%). Conclusions: iRARC has favorable perioperative outcomes, fewer complications, and comparable long-term survival outcomes, including locally advanced (≥ cT3) disease, compared to that in ORC. Our results need to be validated in prospective randomized clinical trials.
UR - http://www.scopus.com/inward/record.url?scp=85106249747&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85106249747&partnerID=8YFLogxK
U2 - 10.1007/s10147-021-01939-3
DO - 10.1007/s10147-021-01939-3
M3 - Article
C2 - 34009486
AN - SCOPUS:85106249747
SN - 1341-9625
VL - 26
SP - 1514
EP - 1523
JO - International Journal of Clinical Oncology
JF - International Journal of Clinical Oncology
IS - 8
ER -