Open versus robot assisted radical cystectomy and orthotopic neobladder: Mid-term single center propensity score matched analysis of perioperative and oncologic outcomes

Giuseppe Simone1, Mariaconsiglia Ferriero1, Salvatore Guaglianone1, Umberto Anceschi2, Leonardo Misuraca1, Gabriele Tuderti1, Francesco Minisola1, Michele Gallucci1
  • 1 Istituto Nazionale Tumori "Regina Elena", Unità di Urologia (Roma)
  • 2 Azienda Provinciale Per i Servizi Sanitari, Urologia (Trento)

Objective

Oncologic equivalence open radical cystectomy (ORC) and robot-assisted radical cystectomy (RARC) remains a debatable issue and prospective randomized trials comparing these two approaches are hard to perform. In this study we compared oncologic outcomes of propensity score matched cohorts of patients treated with either ORC and orthotopic neobladder (ON) or RARC and intracorporeal ON.

Materials and Methods

The institutional review board approved prospective bladder cancer database was queried for “cystectomy with curative intent” and “neobladder”. A 1:1 PSM analysis was used to minimize the potential biases of a retrospective analysis of data. Kaplan-Meier method was used to compare the oncologic outcomes of the PSM cohorts. Survival rates were computed at 2, 3 and 4 years after surgery and the log rank test was applied to assess statistical significance between the two PSM groups.

Results

Overall 363 patients with a minimum follow-up length of 2 years were included, 299 of which treated with ORC and 64 with RARC.
Patients treated with open surgery were less frequently male (p=0.08), with higher pT stage (p=0.003), higher incidence of non-urothelial histologies (0.05) and lesser adoption of neoadjuvant chemotherapy (<0.001). After applying the PSM, 64 RARC patients were matched with 46 ORC cases. The two groups did not differ for all clinical and pathologic variables included in the analysis (all p ≥0.22). All data are summarized in table 1.
At Kaplan-Meier analysis RARC and ORC cohorts displayed comparable disease free survival (log rank p= 0.894; Figure 1a), cancer specific survival (log rank p=0.8; Figure 1b) and overall survival rates (log rank p= 0.97; Figure 1c).

Conclusion

RARC with intracorporeal neobladder provides an optimal control of soft tissue surgical margins and of LN yield. Preliminary oncologic outcomes suggest that patients treated with RARC and intracorporeal neobladder display comparable disease free survival of patients treated with open surgery.

Reference

– Robotic Intracorporeal Padua Ileal Bladder: Surgical Technique, Perioperative, Oncologic and Functional Outcomes.
Simone G, Papalia R, Misuraca L, Tuderti G, Minisola F, Ferriero M, Vallati G, Guaglianone S, Gallucci M.
Eur Urol. 2016 Oct 22. pii: S0302-2838(16)30721-7. doi: 10.1016/j.eururo.2016.10.018. [Epub ahead of print]

– Perioperative and oncologic outcomes of robot-assisted vs. open radical cystectomy in bladder cancer patients: A comparison of two high-volume referral centers.
Gandaglia G, Karl A, Novara G, de Groote R, Buchner A, D'Hondt F, Montorsi F, Stief C, Mottrie A, Gratzke C.
Eur J Surg Oncol. 2016 Nov;42(11):1736-1743. doi: 10.1016/j.ejso.2016.02.254.

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