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Early Recurrence Patterns Following Totally Intracorporeal Robot-assisted Radical Cystectomy: Results from the EAU Robotic Urology Section (ERUS) Scientific Working Group

European Urology, Volume 71, Issue 5, May 2017, Pages 723 - 726

Abstract

Recurrence following radical cystectomy often occurs early, with >80% of recurrences occurring within the first 2 yr. Debate remains as to whether robot-assisted radical cystectomy (RARC) negatively impacts early recurrence patterns because of inadequate resection or pneumoperitoneum. We report early recurrence patterns among 717 patients who underwent RARC with intracorporeal urinary diversion at nine different institutions with a minimum follow-up of 12 mo. Clinical, pathologic, radiologic, and survival data at the latest follow-up were collected. Recurrence-free survival (RFS) estimates were generated using the Kaplan-Meier method, and Cox regression models were built to assess variables associated with recurrence. RFS at 3, 12, and 24 mo was 95.9%, 80.2%, and 74.6% respectively. Distant recurrences most frequently occurred in the bones, lungs, and liver, and pelvic lymph nodes were the commonest site of local recurrence. We identified five patients (0.7%) with peritoneal carcinomatosis and two patients (0.3%) with metastasis at the port site (wound site). We conclude that unusual recurrence patterns were not identified in this multi-institutional series and that recurrence patterns appear similar to those in open radical cystectomy series.

Patient summary

In this multi-institutional study, bladder cancer recurrences following robotic surgery are described. Early recurrence rates and locations appear to be similar to those for open radical cystectomy series.

Take Home Message

This multi-institutional series analyses early recurrence patterns among patients undergoing robot-assisted radical cystectomy for bladder cancer. No unusual recurrence patterns were identified. Early recurrence rates and locations appear similar to those for open series. Pathologic staging and lymph node status were associated with recurrences.

Keywords: Robot-assisted radical cystectomy, Early recurrence patterns, Oncologic outcomes, Totally intracorporeal robot-assisted radical cystectomy.

Footnotes

a Karolinska University Hospital, Stockholm, Sweden

b Karolinska Institute, Stockholm, Sweden

c Bristol Urological Institution, Bristol, UK

d St. Georges Hospital London, London, UK

e Hirslanden Klinik, Aarau, Switzerland

f Carl Wijburg, Rijnstate, Arnhem, The Netherlands

g Ankara Ataturk Hospital, Ankara, Turkey

h Memorial Sisli Hospital, Istanbul, Turkey

i Ghent University Hospital, Ghent, Belgium

j University of Tübingen, Tübingen, Germany

k Da Vinci Zentrum, Hanover, Germany

l O.L.V, Clinic, Aalst, Belgium

Corresponding author. Department of Urology, Karolinska University Hospital, 171 76 Stockholm, Sweden. Tel. +46 8 51772854; Fax: +46 8 51773599.

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