The University of Southampton
University of Southampton Institutional Repository

Robot-assisted versus open radical cystectomy in patients receiving perioperative chemotherapy for muscle-invasive bladder cancer: The oncologist's perspective from a multicentre study

Robot-assisted versus open radical cystectomy in patients receiving perioperative chemotherapy for muscle-invasive bladder cancer: The oncologist's perspective from a multicentre study
Robot-assisted versus open radical cystectomy in patients receiving perioperative chemotherapy for muscle-invasive bladder cancer: The oncologist's perspective from a multicentre study

Background: Little is known about the outcomes of robot-assisted radical cystectomy (RARC) compared to open radical cystectomy (ORC) combined with perioperative chemotherapy for muscle-invasive urothelial bladder cancer (UBC).

Objective: To evaluate surgical and oncological outcomes for RARC and ORC in multimodal treatment.

Design, setting, and participants: Data from 28 centres were collected for cystectomies performed between January 2000 and July 2013.

Intervention: RARC or ORC combined with perioperative chemotherapy for UBC.

Outcome measures and statistical analysis: Fisher's exact tests, χ2 tests, and Wilcoxon rank-sum tests were used to compare the RARC and ORC groups. Logistic and Cox regression analyses were performed to evaluate potential prognostic factors.

Results and limitations: A total of 688 patients (n = 603 ORC and n = 85 RARC) were analysed; 60.6% received neoadjuvant chemotherapy, and 45.1% adjuvant chemotherapy. No significant differences in baseline characteristics were found between the groups. The median time from surgery to adjuvant chemotherapy was 1.9 mo for both RARC and ORC groups. The median number of lymph nodes removed was 21 (interquartile range [IQR] 14-35) for RARC and 13 (IQR 8-21) for ORC (p< 0.001); the results were confirmed in subgroup analyses. Multivariable analyses revealed no difference in the rate of positive surgical margins (p = 0.54 and p = 0.78), rate of neobladder diversion (p = 0.33 and p = 0.51), relapse-free survival (p = 0.31 and p = 0.23), and overall survival (p = 0.63 and p = 0.69). The retrospective nature of the data is the major limitation.

Conclusions: In this study, no differences in efficacy outcomes or ability to deliver adjuvant chemotherapy were observed between RARC and ORC. The increasing use of RARC is justifiable from an oncological viewpoint.

Patient summary: In a retrospective study of patients who received perioperative chemotherapy for urothelial bladder cancer, we found no difference in key outcomes between robot-assisted radical cystectomy (RARC) and open radical cystectomy. Performing RARC seems to be justifiable in the multidisciplinary setting. In contemporary cohorts of patients who have received perioperative chemotherapy for muscle-invasive bladder cancer, no substantial differences were found between robot-assited radical cystectomy (RARC) and open radical cystectomy, and the number of lymph nodes removed was higher with RARC.

Cystectomy, Muscle-invasive disease, Perioperative chemotherapy, Robot-assisted surgery, Urothelial carcinoma
Necchi, Andrea
fb44790a-f8fe-43b6-ad82-72cf5b9107d6
Pond, Gregory R.
4bb3025c-b5e3-49c6-87e8-3d4eeca8ef0f
Smaldone, Marc C.
bf2d7b73-495d-4d73-95d4-67372bf5f92a
Pal, Sumanta K.
62b6ea1e-83c1-4ba7-a37a-c813fe15b55c
Chan, Kevin
82e11fce-7116-4884-968a-95ff3e0fa06a
Wong, Yu Ning
125bb23b-f892-4ac8-ae7a-c8a362acf341
Viterbo, Rosalia
43944bce-be3e-490d-bfe2-e3ef9a3c0d0f
Sonpavde, Guru
dd5a4609-98b4-4ddf-ba8f-d95a0f4e2c9c
Harshman, Lauren C.
65c2410e-23a7-49e4-b2ac-05409f320222
Crabb, Simon
bcd1b566-7677-4f81-8429-3ab0e85f8373
Alva, Ajjai
c20f8921-bce9-479c-ade0-b0686ff72d4d
Chowdhury, Simon
74cdad3c-31c9-4c77-9f24-e87debb9139e
De Giorgi, Ugo
86c9f3a7-1680-4a3f-a34f-32cab5d47b4f
Srinivas, Sandy
4dd68ce5-fe05-4613-b029-49082edacc32
Agarwal, Neeraj
ca5b2c21-6702-48d8-a138-56d7e9cfca17
Bamias, Aristotelis
d7ea23db-1f9f-4ad8-bff7-b3316eec610d
Baniel, Jack
fce42171-4c34-4bc1-896b-484471830852
Golshayan, Ali Reza
9445f0de-0cb3-4a58-9035-3f5caffd9854
Ladoire, Sylvain
62c6053f-7695-4c1e-aa07-eeb98caaf17e
Sternberg, Cora N.
fece0083-29af-4bf4-a90d-04159da38beb
Cerbone, Linda
d2fa333c-04d2-49f0-9e78-cc508cc2ec81
Yu, Evan Y.
3f986437-70b2-4993-90d9-13d06e155d8c
Bellmunt, Joaquim
a9cece8e-55c5-4e2e-bb1f-aec7aa8cba91
Vaishampayan, Ulka
d2d140dc-26fc-457b-8c20-86e41271a02f
Niegisch, Gunter
9b94435f-5bb8-47a5-a2c6-39303c8116bd
Hussain, Syed
04946d73-9bda-446a-8fd1-fc98c63e9eed
Bowles, Daniel W.
8456712b-04a7-4046-8847-3e7280fa480c
Morales-Barrera, Rafael
abe4cfe5-5e40-4e5f-bd6a-bf0f9ca4a434
Milowsky, Matthew I.
1d32c8eb-9a9f-4b06-b73c-a8fe4f507269
Theodore, Christine
585e90d8-8d1f-4198-902f-723f6c3a4822
Berthold, Dominik R.
e3f702dd-1dc5-48cc-84dd-175b31bb79a9
Sridhar, Srikala S.
ce4e2322-0e41-4d5c-b8ad-2f598c0b728a
Powles, Thomas
55539b87-1c5e-45ae-9e07-5b2232c2236c
Rosenberg, Jonathan E.
b9e011ca-9408-4366-baea-5f487a246938
Galsky, Matthew D.
57bcde2a-bfea-490b-8a09-8ee8e28563da
Necchi, Andrea
fb44790a-f8fe-43b6-ad82-72cf5b9107d6
Pond, Gregory R.
4bb3025c-b5e3-49c6-87e8-3d4eeca8ef0f
Smaldone, Marc C.
bf2d7b73-495d-4d73-95d4-67372bf5f92a
Pal, Sumanta K.
62b6ea1e-83c1-4ba7-a37a-c813fe15b55c
Chan, Kevin
82e11fce-7116-4884-968a-95ff3e0fa06a
Wong, Yu Ning
125bb23b-f892-4ac8-ae7a-c8a362acf341
Viterbo, Rosalia
43944bce-be3e-490d-bfe2-e3ef9a3c0d0f
Sonpavde, Guru
dd5a4609-98b4-4ddf-ba8f-d95a0f4e2c9c
Harshman, Lauren C.
65c2410e-23a7-49e4-b2ac-05409f320222
Crabb, Simon
bcd1b566-7677-4f81-8429-3ab0e85f8373
Alva, Ajjai
c20f8921-bce9-479c-ade0-b0686ff72d4d
Chowdhury, Simon
74cdad3c-31c9-4c77-9f24-e87debb9139e
De Giorgi, Ugo
86c9f3a7-1680-4a3f-a34f-32cab5d47b4f
Srinivas, Sandy
4dd68ce5-fe05-4613-b029-49082edacc32
Agarwal, Neeraj
ca5b2c21-6702-48d8-a138-56d7e9cfca17
Bamias, Aristotelis
d7ea23db-1f9f-4ad8-bff7-b3316eec610d
Baniel, Jack
fce42171-4c34-4bc1-896b-484471830852
Golshayan, Ali Reza
9445f0de-0cb3-4a58-9035-3f5caffd9854
Ladoire, Sylvain
62c6053f-7695-4c1e-aa07-eeb98caaf17e
Sternberg, Cora N.
fece0083-29af-4bf4-a90d-04159da38beb
Cerbone, Linda
d2fa333c-04d2-49f0-9e78-cc508cc2ec81
Yu, Evan Y.
3f986437-70b2-4993-90d9-13d06e155d8c
Bellmunt, Joaquim
a9cece8e-55c5-4e2e-bb1f-aec7aa8cba91
Vaishampayan, Ulka
d2d140dc-26fc-457b-8c20-86e41271a02f
Niegisch, Gunter
9b94435f-5bb8-47a5-a2c6-39303c8116bd
Hussain, Syed
04946d73-9bda-446a-8fd1-fc98c63e9eed
Bowles, Daniel W.
8456712b-04a7-4046-8847-3e7280fa480c
Morales-Barrera, Rafael
abe4cfe5-5e40-4e5f-bd6a-bf0f9ca4a434
Milowsky, Matthew I.
1d32c8eb-9a9f-4b06-b73c-a8fe4f507269
Theodore, Christine
585e90d8-8d1f-4198-902f-723f6c3a4822
Berthold, Dominik R.
e3f702dd-1dc5-48cc-84dd-175b31bb79a9
Sridhar, Srikala S.
ce4e2322-0e41-4d5c-b8ad-2f598c0b728a
Powles, Thomas
55539b87-1c5e-45ae-9e07-5b2232c2236c
Rosenberg, Jonathan E.
b9e011ca-9408-4366-baea-5f487a246938
Galsky, Matthew D.
57bcde2a-bfea-490b-8a09-8ee8e28563da

Necchi, Andrea, Pond, Gregory R., Smaldone, Marc C., Pal, Sumanta K., Chan, Kevin, Wong, Yu Ning, Viterbo, Rosalia, Sonpavde, Guru, Harshman, Lauren C., Crabb, Simon, Alva, Ajjai, Chowdhury, Simon, De Giorgi, Ugo, Srinivas, Sandy, Agarwal, Neeraj, Bamias, Aristotelis, Baniel, Jack, Golshayan, Ali Reza, Ladoire, Sylvain, Sternberg, Cora N., Cerbone, Linda, Yu, Evan Y., Bellmunt, Joaquim, Vaishampayan, Ulka, Niegisch, Gunter, Hussain, Syed, Bowles, Daniel W., Morales-Barrera, Rafael, Milowsky, Matthew I., Theodore, Christine, Berthold, Dominik R., Sridhar, Srikala S., Powles, Thomas, Rosenberg, Jonathan E. and Galsky, Matthew D. (2017) Robot-assisted versus open radical cystectomy in patients receiving perioperative chemotherapy for muscle-invasive bladder cancer: The oncologist's perspective from a multicentre study. European Urology Focus. (doi:10.1016/j.euf.2017.03.011).

Record type: Article

Abstract

Background: Little is known about the outcomes of robot-assisted radical cystectomy (RARC) compared to open radical cystectomy (ORC) combined with perioperative chemotherapy for muscle-invasive urothelial bladder cancer (UBC).

Objective: To evaluate surgical and oncological outcomes for RARC and ORC in multimodal treatment.

Design, setting, and participants: Data from 28 centres were collected for cystectomies performed between January 2000 and July 2013.

Intervention: RARC or ORC combined with perioperative chemotherapy for UBC.

Outcome measures and statistical analysis: Fisher's exact tests, χ2 tests, and Wilcoxon rank-sum tests were used to compare the RARC and ORC groups. Logistic and Cox regression analyses were performed to evaluate potential prognostic factors.

Results and limitations: A total of 688 patients (n = 603 ORC and n = 85 RARC) were analysed; 60.6% received neoadjuvant chemotherapy, and 45.1% adjuvant chemotherapy. No significant differences in baseline characteristics were found between the groups. The median time from surgery to adjuvant chemotherapy was 1.9 mo for both RARC and ORC groups. The median number of lymph nodes removed was 21 (interquartile range [IQR] 14-35) for RARC and 13 (IQR 8-21) for ORC (p< 0.001); the results were confirmed in subgroup analyses. Multivariable analyses revealed no difference in the rate of positive surgical margins (p = 0.54 and p = 0.78), rate of neobladder diversion (p = 0.33 and p = 0.51), relapse-free survival (p = 0.31 and p = 0.23), and overall survival (p = 0.63 and p = 0.69). The retrospective nature of the data is the major limitation.

Conclusions: In this study, no differences in efficacy outcomes or ability to deliver adjuvant chemotherapy were observed between RARC and ORC. The increasing use of RARC is justifiable from an oncological viewpoint.

Patient summary: In a retrospective study of patients who received perioperative chemotherapy for urothelial bladder cancer, we found no difference in key outcomes between robot-assisted radical cystectomy (RARC) and open radical cystectomy. Performing RARC seems to be justifiable in the multidisciplinary setting. In contemporary cohorts of patients who have received perioperative chemotherapy for muscle-invasive bladder cancer, no substantial differences were found between robot-assited radical cystectomy (RARC) and open radical cystectomy, and the number of lymph nodes removed was higher with RARC.

Text
Draft02_RARC vs ORS - Accepted Manuscript
Download (58kB)

More information

Accepted/In Press date: 17 March 2017
e-pub ahead of print date: 31 March 2017
Keywords: Cystectomy, Muscle-invasive disease, Perioperative chemotherapy, Robot-assisted surgery, Urothelial carcinoma
Organisations: University of Southampton

Identifiers

Local EPrints ID: 411634
URI: http://eprints.soton.ac.uk/id/eprint/411634
PURE UUID: 260d53fa-1e7b-4d6a-af2c-fc85f68980b8
ORCID for Simon Crabb: ORCID iD orcid.org/0000-0003-3521-9064

Catalogue record

Date deposited: 21 Jun 2017 16:31
Last modified: 16 Mar 2024 05:23

Export record

Altmetrics

Contributors

Author: Andrea Necchi
Author: Gregory R. Pond
Author: Marc C. Smaldone
Author: Sumanta K. Pal
Author: Kevin Chan
Author: Yu Ning Wong
Author: Rosalia Viterbo
Author: Guru Sonpavde
Author: Lauren C. Harshman
Author: Simon Crabb ORCID iD
Author: Ajjai Alva
Author: Simon Chowdhury
Author: Ugo De Giorgi
Author: Sandy Srinivas
Author: Neeraj Agarwal
Author: Aristotelis Bamias
Author: Jack Baniel
Author: Ali Reza Golshayan
Author: Sylvain Ladoire
Author: Cora N. Sternberg
Author: Linda Cerbone
Author: Evan Y. Yu
Author: Joaquim Bellmunt
Author: Ulka Vaishampayan
Author: Gunter Niegisch
Author: Syed Hussain
Author: Daniel W. Bowles
Author: Rafael Morales-Barrera
Author: Matthew I. Milowsky
Author: Christine Theodore
Author: Dominik R. Berthold
Author: Srikala S. Sridhar
Author: Thomas Powles
Author: Jonathan E. Rosenberg
Author: Matthew D. Galsky

Download statistics

Downloads from ePrints over the past year. Other digital versions may also be available to download e.g. from the publisher's website.

View more statistics

Atom RSS 1.0 RSS 2.0

Contact ePrints Soton: eprints@soton.ac.uk

ePrints Soton supports OAI 2.0 with a base URL of http://eprints.soton.ac.uk/cgi/oai2

This repository has been built using EPrints software, developed at the University of Southampton, but available to everyone to use.

We use cookies to ensure that we give you the best experience on our website. If you continue without changing your settings, we will assume that you are happy to receive cookies on the University of Southampton website.

×