Long-term oncologic outcomes and complications of robot-assisted radical cystectomy for the treatment of urothelial carcinoma of the bladder.

Autor: Lama DJ; Division of Urology and Urologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA. Electronic address: dlama@coh.org., Okunowo O; Department of Computational and Quantitative Medicine, Division of Biostatistics, Beckman Research Institute of City of Hope, Duarte, CA., Yamzon J; Division of Urology and Urologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA., Zhumkhawala AA; Division of Urology and Urologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA., Wilson TG; Division of Urology and Urologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA; Department of Urologic Oncology, Providence St. John's Cancer Institute, Santa Monica, CA., Lau CS; Division of Urology and Urologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA., Yuh BE; Division of Urology and Urologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA., Chan KG; Division of Urology and Urologic Oncology, Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA.
Jazyk: angličtina
Zdroj: Urologic oncology [Urol Oncol] 2024 Oct 22. Date of Electronic Publication: 2024 Oct 22.
DOI: 10.1016/j.urolonc.2024.10.009
Abstrakt: Introduction: To report the long-term outcomes of robot-assisted radical cystectomy (RARC) for the treatment of muscle invasive and high-risk non-muscle invasive bladder cancer.
Methods: We reviewed a single tertiary center database of RARC from 2004 to 2020. Concomitant extended pelvic lymph node dissection and extracorporeal urinary diversion were performed. Cox regression analysis and the Kaplan-Meier method were used to identify factors associated with and report time-to-event estimations of recurrence-free survival and overall survival. Clavien-Dindo complications were identified, categorized, and substratified by time from surgery within 90-days and between 90-days and >5-years postoperatively.
Results: A total of 510 patients with median follow-up of 57.1 months (IQR 21.8-103.6) were included. Continent diversion was performed in 259 (51%) patients. Of the 340 (67%) ≥cT2 patients, 153 (45%) received cisplatin-based neoadjuvant chemotherapy. Recurrence was identified in 157 (31%) patients, and 118 (23%) died from bladder cancer. The overall complication rate was 52% with 267 (41%) major grade ≥ III events. Infectious (25%) and genitourinary (22%) complications were the most common irrespective of the time interval beyond 90-days. The risk of recurrence or death were increased by extravesical disease (HR 1.91 and 1.97, respectively) and lymph node positivity (HR 4.58 and 2.42, respectively) in multivariable analysis (all, P < 0.001). The estimated 5-, and 10-year recurrence-free and overall survival rates were 69% and 64% and 61% and 44%, respectively.
Conclusions: RARC is a durable treatment that optimizes the probability of cure for patients requiring extirpation for bladder cancer. Targeting the modifiable complications of radical surgery may further improve the risk/benefit ratio of RARC.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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