J Urol. 2020 Sep 18:101097JU0000000000001380. doi: 10.1097/JU.0000000000001380. Online ahead of print.
INTRODUCTION AND OBJECTIVES: There have been concerns about higher incidence of local and retroperitoneal recurrences after robot-assisted radical cystectomy (RARC) compared to open radical cystectomy. We sought to report and detail relapses following RARC utilizing a multinational database.
METHODS: A retrospective review of the International Robotic Cystectomy Consortium was performed. Data were reviewed for demographics, perioperative, pathologic and oncologic outcomes. Relapse rates and patterns were analyzed. Kaplan Meier curves were used to depict relapse-free (RFS), local recurrence-free (LRFS), distant metastases-free survival (DMFS), and overall survival (OS). Kaplan Meier curves were further stratified by disease stage, lymph node status, and margins. Multivariate stepwise Cox regression models were used to identify variables associated with RFS, LRFS, DMFS and OS.
RESULTS: Of 2107 patients, 521 (25%) relapsed. Mean age was 68 ± 10 years, with a median follow up of 26 (IQR 11-55) months for the study cohort. Local recurrences were observed in 11% and distant metastases in 18%. Early oncologic failure (within 3 months) occurred in 4%. The most common sites of local recurrence and distant metastases were the pelvis (5%) and lungs (6%) respectively. Abdominal wall/port-site metastases occurred in 1.2% and peritoneal carcinomatosis in 1.2%. The 5-year RFS, LRFS, DMFS, and OS were 66%, 84%, 74%, and 60% respectively. Patient with higher disease stage, pN+ve, and positive soft tissue surgical margins demonstrated worse RFS, LRFS, DMFS, and OS (log rank p<0.01 for all comparisons). Multivariate regression models identified that node positive status and disease stage (≥pT3) were significantly associated with RFS, LRFS, DMFS, and OS (p<0.01).
CONCLUSION: Disease stage remains the main variable associated with disease relapse and survival following RC. RARC was not associated with different patterns or higher relapse rates in comparison to historic open radical cystectomy data.