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.

Long-term oncologic outcomes of robot-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion (ICUD): a multi-center study / Brassetti, A.; Cacciamani, G.; Anceschi, U.; Ferriero, M.; Tuderti, G.; Miranda, G.; Mastroianni, R.; Desai, M.; Aron, M.; Gill, I.; Gallucci, M.; Simone, G.. - In: WORLD JOURNAL OF UROLOGY. - ISSN 0724-4983. - 38:4(2020), pp. 837-843. [10.1007/s00345-019-02842-3]

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

Brassetti A.;Anceschi U.;Ferriero M.;Tuderti G.;Miranda G.;Mastroianni R.;Aron M.;Gallucci M.;
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.
2020
Bladder cancer; Long-term outcomes; Radical cystectomy; Robotic; Survival; Urothelial carcinoma
01 Pubblicazione su rivista::01a Articolo in rivista
Long-term oncologic outcomes of robot-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion (ICUD): a multi-center study / Brassetti, A.; Cacciamani, G.; Anceschi, U.; Ferriero, M.; Tuderti, G.; Miranda, G.; Mastroianni, R.; Desai, M.; Aron, M.; Gill, I.; Gallucci, M.; Simone, G.. - In: WORLD JOURNAL OF UROLOGY. - ISSN 0724-4983. - 38:4(2020), pp. 837-843. [10.1007/s00345-019-02842-3]
File allegati a questo prodotto
File Dimensione Formato  
Brassetti_Long-term-Oncologic-Outcomes_2020.pdf

solo gestori archivio

Tipologia: Versione editoriale (versione pubblicata con il layout dell'editore)
Licenza: Tutti i diritti riservati (All rights reserved)
Dimensione 870.84 kB
Formato Adobe PDF
870.84 kB Adobe PDF   Contatta l'autore

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1418406
Citazioni
  • ???jsp.display-item.citation.pmc??? 11
  • Scopus 31
  • ???jsp.display-item.citation.isi??? 30
social impact