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Recurrence Patterns After Open and Robot-assisted Radical Cystectomy for Bladder Cancer

European Urology, Volume 68, Issue 3, September 2015, Pages 399 - 405

Abstract

Background

Concerns remain whether robot-assisted radical cystectomy (RARC) compromises survival because of inadequate oncologic resection or alteration of recurrence patterns.

Objective

To describe recurrence patterns following open radical cystectomy (ORC) and RARC.

Design, setting, and participants

Retrospective review of 383 consecutive patients who underwent ORC (n = 120) or RARC (n = 263) at an academic institution from July 2001 to February 2014.

Intervention

ORC and RARC.

Outcome measurements and statistical analysis

Recurrence-free survival estimates were illustrated using the Kaplan-Meier method. Recurrence patterns (local vs distant and anatomic locations) within 2 yr of surgery were tabulated. Cox regression models were built to evaluate the effect of surgical technique on the risk of recurrence.

Results and limitations

The median follow-up time for patients without recurrence was 30 mo (interquartile range [IQR] 5–72) for ORC and 23 mo (IQR 9–48) for RARC (p = 0.6). Within 2 yr of surgery, there was no large difference in the number of local recurrences between ORC and RARC patients (15/65 [23%] vs 24/136 [18%]), and the distribution of local recurrences was similar between the two groups. Similarly, the number of distant recurrences did not differ between the groups (26/73 [36%] vs 43/147 [29%]). However, there were distinct patterns of distant recurrence. Extrapelvic lymph node locations were more frequent for RARC than ORC (10/43 [23%] vs 4/26 [15%]). Furthermore, peritoneal carcinomatosis was found in 9/43 (21%) RARC patients compared to 2/26 (8%) ORC patients. In multivariable analyses, RARC was not a predictor of recurrence. Limitations of the study include selection bias and a limited sample size.

Conclusions

Within limitations, we found that RARC is not an independent predictor of recurrence after surgery. Interestingly, extrapelvic lymph node locations and peritoneal carcinomatosis were more frequent in RARC than in ORC patients. Further validation is warranted to better understand the oncologic implications of RARC.

Patient summary

In this study, the locations of bladder cancer recurrences following conventional and robotic techniques for removal of the bladder are described. Although the numbers are small, the results show that the distribution of distant recurrences differs between the two techniques.

Take Home Message

Within limitations, among patients undergoing open or robot-assisted radical cystectomy, the latter was not a predictor of recurrence. However, there are distinct patterns of recurrence, as extrapelvic lymph node locations and peritoneal carcinomatosis were more frequent in robotically treated patients.

Keywords: Bladder cancer, Open radical cystectomy, Robot-assisted radical cystectomy, Recurrence, Local, Distant.

Footnotes

a Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY, USA

b Department of Urology, Bern University Hospital, Bern, Switzerland

c Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, NY, USA

d Department of Medicine, Division of Hematology/Medical Oncology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY, USA

Corresponding author. Department of Urology, Weill Cornell Medical College, 525 E 68th St, New York, NY 10021, USA. Tel. +1 646 6331322; Fax: +1 212 7468941.