Robot-Assisted Cystectomy May Lead to Good Surgical, Oncologic Outcomes in Bladder Cancer

Robotic-assisted radical cystectomy (RARC) may lead to similar 2-year oncological outcomes among patients with urothelial bladder carcinoma with an extracorporeal urinary diversion compared with open radical cystectomy (ORC), according to a study published in Urologia Internationalis.¹

Radical cystectomy is the standard of care for nonmetastatic muscle-invasive and high-risk non-muscle invasive urothelial carcinoma of the bladder, and is traditionally performed as open surgery. With the advent of minimally invasive surgery programs, RARC is becoming a point of interest for bladder cancer. Although previous studies have evaluated outcomes in ORC and RARC, further study pertaining to survival and recurrence is required.

For this study, researchers included 148 patients with urothelial carcinoma of the bladder; the surgical outcomes of 89 and 59 patients who underwent RARC and ORC, respectively, were compared. The median follow-up of the RARC group was 32 months and 47.5 months for patients in the ORC group.

Results showed that overall survival (OS) was comparable between the study groups (P = .6) as well as the cancer-specific mortality (CSM)-free survival rate (P = .2).

The 2-year OS rate was 80% among patients who underwent RARC compared with 65.3% for patients who underwent ORC; the 2-year CSM survival rate was 90% in the RARC group compared with 70.7% in the ORC group (all P > 0.5).

No significant differences were observed for margin status  after-surgery between the groups.

Early clinical recurrence, defined as recurrence at 6 months or less post-cystectomy, was observed in 11% and 12% of patients in the RARC and ORC groups, respectively (P = .9). In addition, there were no notable differences in metastatic pattern or atypical metastases.

The authors concluded that “not only perioperative surgical quality but also oncological quality of RARC is equal to conventional ORC. However, longer follow-up data and higher number of evaluable patients are required before definitive conclusions can be drawn.”

Reference

1. Niegisch G, Nini A, Michalski R, et al. Comparison of 2-year oncological outcome and early recurrence patterns in patients with urothelial bladder carcinoma treated with open or robot-assisted radical cystectomy with an extracorporeal urinary diversion [published online July 25, 2018]. Urol Int. doi: 10.1159/000491588