Ali Al-Daghmin

Long-term Oncologic Outcomes Following Robot-assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium

BACKGROUND Long-term oncologic data on patients undergoing robot-assisted radical cystectomy (RARC) are limited and based largely on single-institution series. OBJECTIVE Report survival outcomes of patients who underwent RARC ≥5 yr ago. DESIGN, SETTING, AND PARTICIPANTS Retrospective review of the prospectively populated International Robotic Cystectomy Consortium multi-institutional database identified 743 patients with RARC performed ≥5 yr ago. Clinical, pathologic, and survival data at the latest follow-up were collected. Patients with palliative RARC were excluded. Final analysis was performed on 702 patients from 11 institutions in 6 countries. INTERVENTION RARC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Outcomes of interest, recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were plotted using Kaplan-Meier survival curves. A Cox proportional hazards model was used to identify factors that predicted outcomes. RESULTS AND LIMITATIONS Pathologic organ-confined (OC) disease was found in 62% of patients. Soft tissue surgical margins (SMs) were positive in 8%. Median lymph node (LN) yield was 16, and 21% of patients had positive LNs. Median follow-up was 67 mo (interquartile range: 18-84 mo). Five-year RFS, CSS, and OS were 67%, 75%, and 50%, respectively. Non-OC disease and SMs were associated with poorer RFS, CSS, and OS on multivariable analysis. Age predicted poorer CSS and OS. Adjuvant chemotherapy and positive SMs were predictors of RFS (hazard ratio: 3.20 and 2.16; p<0.001 and p<0.005, respectively). Stratified survival curves demonstrated poorer outcomes for positive SM, LN, and non-OC disease. Retrospective interrogation and lack of contemporaneous comparison groups that underwent open radical cystectomy were major limitations. CONCLUSIONS The largest multi-institutional series to date reported long-term survival outcomes after RARC. PATIENT SUMMARY Patients who underwent robot-assisted radical cystectomy for bladder cancer have acceptable long-term survival.

Oncologic Outcomes Following Robot-assisted Radical Cystectomy with Minimum 5-year Follow-up: The Roswell Park Cancer Institute Experience

BACKGROUND Long-term oncologic outcomes following robot-assisted radical cystectomy (RARC) remain scarce. OBJECTIVE To report long-term oncologic outcomes following RARC at a single institution. DESIGN, SETTINGS, AND PARTICIPANTS Retrospective review of 99 patients who underwent RARC for urothelial carcinoma of bladder between 2005 and 2009. INTERVENTION RARC was performed. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary outcomes included recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS), measured by the Kaplan-Meier method. The association between primary outcomes and perioperative and pathologic factors was assessed using a multivariable Cox proportional hazards model. RESULTS AND LIMITATIONS Fifty-one (52%) patients had stage pT3 or higher disease. Eight (8%) patients had positive margins and 30 (30%) had positive lymph nodes (LNs), with a median of 21 LNs removed. Median follow-up for patients alive was 74 mo. The 5-yr RFS, CSS, and OS rates were 52.5%, 67.8%, and 42.4%, respectively. Tumor stage, LN stage, and margin status were each significantly associated with RFS, CSS, and OS. On multivariable analysis, tumor and LN stage were independent predictors of RFS, CSS, and OS, while positive margin status and Charlson comorbidity index predicted worse OS and CSS. Adjuvant chemotherapy predicted RFS only. Retrospective design and lack of open comparison are main limitations of this study. CONCLUSIONS Long-term oncologic outcomes following RARC demonstrate RFS and CSS estimates similar to those reported in literature for open radical cystectomy. Randomized controlled trials can better define outcomes of any alternative technique. PATIENT SUMMARY Survival data 5 yr after RARC for bladder cancer demonstrate that survival outcomes are dependent on the same oncologic parameters as previously reported for open surgery.

Efficacy of robot-assisted radical cystectomy (RARC) in advanced bladder cancer: results from the International Radical Cystectomy Consortium (IRCC)

To characterise the surgical feasibility and outcomes of robot‐assisted radical cystectomy (RARC) for pathological T4 bladder cancer.

Robot-assisted intracorporeal urinary diversion: where do we stand in 2014?

Radical cystectomy can only be considered as minimally invasive when both extirpative and reconstructive part of the procedure are performed with an intracorporeal approach. Robot-assisted radical cystectomy makes it possible to achieve this task, which seemed difficult with conventional laparoscopy. Intracorporeal urinary diversion (ICUD) is associated with better perioperative outcomes. Quality-of-life assessments and functional outcomes from continent ICUD are encouraging. Working in high-volumes center with mentored training can help robotic surgeons to learn the techniques of ICUD in conjunction with robot-assisted radical cystectomy. This article discusses the perioperative and functional outcomes of ICUD with a review of literature.

External validation of preoperative and postoperative nomograms for prediction of cancer-specific survival, overall survival and recurrence after robot-assisted radical cystectomy for urothelial carcinoma of the bladder

To externally validate currently available bladder cancer nomograms for prediction of all‐cause survival (ACS), cancer‐specific survival (CSS), other‐cause mortality (OCM) and progression‐free survival (PFS).

Efficacy of robot-assisted radical cystectomy (RARC) in advanced bladder cancer: results from the International Radical Cystectomy Consortium (IRCC): Efficacy of RARC in advanced bladder cancer

To characterise the surgical feasibility and outcomes of robot‐assisted radical cystectomy (RARC) for pathological T4 bladder cancer.

Efficacy of Robot-assisted Radical Cystectomy in Advanced Bladder Cancer

To characterise the surgical feasibility and outcomes of robot‐assisted radical cystectomy (RARC) for pathological T4 bladder cancer.