Presentation Authors: Giovanni Cacciamani*, Matthew Winter, Luis Medina, Akbar Ashrafi, Gus Miranda, Hannah Landberger, Michael Lin-Brande, Alessandro Tafuri, Nieroshan Rajarubendra, Andre De Castro Abreu, Andre Berger, Monish Aron, Inderbir Gill, Mihir Desai, Los Angeles, CA
Introduction: To propose a standardisable composite method for reporting outcomes of radical cystectomy (RC) that incorporates both peri-operative morbidity and oncologic adequacy.
Methods: From July 2010 through December 2017, 277 consecutive patients who underwent robotic radical cystectomy (RRC) for bladder cancer at our institution were prospectively analysed. IRB approval was obtained (HS-01B014). Patients who simultaneously demonstrated negative soft tissue surgical margins, =/> 16 lymph node yield, absence of major (Clavien-Dindo grade III-IV) complications at 90 days, absence of urinary diversion (UD) related long-term sequelae and absence of clinical recurrence at =/ < 12 mo. were considered as having achieved the RC-pentafecta. We created a multivariable logistic regression model using age, ASA score, type of UD, NACH, pT and pN stage as covariates to measure independent factors for achieving RC-pentafecta. The internal validity of the prediction model was assessed by 1000 bootstrap samples with a two-tailed p-value less than 0.05 being statistically significant. (SPSS 24 Inc., Chicago, IL, USA).
Results: Since 2010, 270 out of 277 patients that had completed at least 12mo. follow-up were included in this analysis. Over a median follow up of 39.5 months, =/> 16 lymph node yield, negative soft surgical margins, absence of major complications at 90 days and absence of UD-related surgical sequelae and clinical recurrence at =/ < 12 months were observed in 93.0%, 98.9%, 76.7%, 81.5% and 92.2%, patients, respectively resulting in a RC-pentafecta of 53.3% (Fig. a). When comparing UD, IC was showed higher RC-pentafecta rate (Fig. B). Multivariable logistic regression analysis revealed age (OR:0.95; p=0.002), type of UD (OR: 2.19; p= 0.01) and pN stage (OR: 0.48; p= 0.03) to be independent predictors for achieving RC-pentafecta. RC-Pentafecta increased from 44.4% to 64.4% in I and III tirtile respectively (Fig. C).
Conclusions: We present RC-pentafecta as a standardisable composite endpoint that incorporates peri-operative morbidity and oncologic adequacy as a potential tool to assess quality of radical cystectomy. This tool may be useful for assessing learning curve and calculating cost effectiveness amongst others but needs to be externally validated in future studies.