BJU Int. 2020 Jul 18. doi: 10.1111/bju.15178. Online ahead of print.
OBJECTIVES: To investigate the oncological significance of robot assisted radical cystectomy (RARC)-related pentafecta among patients with bladder cancer.
PATIENTS AND METHODS: Using the KORAC database (containing data from 12 centers), data from 730 patients who underwent RARC between April 2007 and May 2019 were prospectively collected and retrospectively analyzed. Pentafecta was achieved if patients met all of the following criteria: 1) negative soft tissue surgical margin, 2) ≥ 16 Lymph node (LN) removed, 3) no major complications (Clavien-Dindo grade 3-5) within 90 days and 4) no clinical recurrence within the first 12 months and 5) no uretero-enteric stricture. Patients were divided into two groups according to pentafecta attainment and followed by a comparison of overall survival (OS) and cancer specific survival (CSS) using the multivariate Cox proportional analysis.
RESULTS: Among the 730 patients included in this analysis, 208 (28.5%) attained RARC-pentafecta; the remaining 522 (71.5%) did not. The mean age of subjects was 64.67 years, 85.1% were males with bladder cancer, 53.6% received a conduit, 37.7% received orthotopic neobladders and the total complication rate was 57.8%. Those who attained pentafecta 1) received more neobladders (p=0.039), 2) were more likely to be treated with the intracorporeal technique (p < 0.001), 3) had longer operating times (p=0.020) and 4) had longer console time (p = 0.021) compared with those who did not attain pentafecta. Over a mean of 31.1 months of follow up, the pentafecta attainment group had significantly higher OS and CSS rates compared with the not-attaiment group, respectively [10 year OS: 70.4% vs. 58.1%, respectively (p=0.016); 10 year CSS: 87.8% vs. 70.0% (p = 0.036)]. Multivariate analysis revealed that RARC-pentafecta was a significant predictor of overall death (HR = 0.561, p = 0.038).
CONCLUSIONS: Patients who attained RARC-pentafecta had significant better survival outcomes compared with those who did not attain pentafecta. Our criteria could be the guideline to standard the surgical quality of RARC. In the future, a similar study using an independent cohort is warranted to help confirm the results achieved here.