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

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Draft02_RARC vs ORS - Accepted Manuscript
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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

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Date deposited: 21 Jun 2017 16:31
Last modified: 07 Oct 2020 06:33

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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
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

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