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Surgical control and margin status after robotic and open cystectomy in high-risk cases: Caution or equivalence?

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Abstract

Purpose

The benefits of robotic-assisted radical cystectomy (RARC) are unclear, especially in patients with high-risk disease (pT3/T4). We evaluated pathological and postoperative outcomes of RARC versus open radical cystectomy (ORC) in these patients.

Methods

We identified bladder cancer patients treated with RARC or ORC from January 2010–August 2014. Clinicodemographic factors were examined for potential confounding. Our primary outcome of interest was positive soft-tissue surgical margins (STSMs). Secondary outcomes included post-operative complications and length of stay (LOS). We used logistic regression to define the association between clinical factors with outcomes of interest, focusing on patients with locally advanced disease.

Results

We identified 472 patients treated with ORC (407, 86.2 %) or RARC (65, 13.8 %) of which 215 (45.6 %) were high-risk cases based on advanced pathologic stage (pT3/4). RARC patients were more commonly men (96.9 vs. 73.2 %, p < 0.01), had better performance status (ECOG 0, 78.5 vs. 59.7 %, p = 0.031), and received less neoadjuvant chemotherapy (21.5 vs. 39.3 %, p = 0.006). Total (52.3 vs. 59.7 %, p = 0.26) and high-grade complication rates (13.8 vs. 19.7 %, p = 0.27) were similar, but median LOS was shorter after RARC (6 vs. 7 days, p < 0.01). On multivariate analysis, prior pelvic radiation (OR: 4.78, 95 % CI: 2.16–10.57), and advanced tumor stage (OR: 3.06, 95 % CI: 1.56–6.03) were independently associated with positive STSMs in high-risk patients but robotic surgical approach was not (OR: 0.81, 95 % CI: 0.29–2.30; p = 0.69).

Conclusion

RARC had similar short-term postoperative outcomes compared to ORC and did not compromise oncological control in patients with extravesical disease.

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Authors contribution

P Sharma, K Zargar-Shoshtari, SM Gilbert: Protocol/project development. P Sharma, and K Zargar-Shoshtari: Data analysis. P Sharma: Manuscript writing. MA Poch, J Pow-Sang, WJ Sexton, PE Spiess, and SM Gilbert: Data collection/management. K Zargar-Shoshtari, MA Poch, J Pow-Sang, WJ Sexton, PE Spiess, and SM Gilbert: Manuscript editing.

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Authors and Affiliations

  1. Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA

    Pranav Sharma, Kamran Zargar-Shoshtari, Michael A. Poch, Julio M. Pow-Sang, Wade J. Sexton, Philippe E. Spiess & Scott M. Gilbert

  2. Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia, Tampa, FL, 33612, USA

    Scott M. Gilbert

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  1. Pranav Sharma
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Correspondence to Scott M. Gilbert.

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All human and animal studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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All persons gave their informed consent prior to their inclusion in the study.

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Sharma, P., Zargar-Shoshtari, K., Poch, M.A. et al. Surgical control and margin status after robotic and open cystectomy in high-risk cases: Caution or equivalence?. World J Urol 35, 657–663 (2017). https://doi.org/10.1007/s00345-016-1915-2

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  • DOI: https://doi.org/10.1007/s00345-016-1915-2

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