Presentation Authors: Akbar N Ashrafi, Pierre-Alain Hueber*, NIeroshan Rajarubendra, Hooman Djaladat, Anne Schuckman, Monish Aron, Mihir Desai, Inderbir Gill, Andre Berger, Los Angeles, CA
Introduction: There is some concern that patterns of recurrence after robotic radical cystectomy (RRC) for bladder cancer may vary compared to open radical cystectomy (ORC) due to prolonged pneumoperitoneum and potential cell seeding. Our objective was to compare rates and patterns of recurrence after RRC and intracorporeal urinary diversion (ICUD) compared to ORC.
Methods: We identified 837 consecutive patients who underwent RRC and ICUD (n=238) or ORC (n=598) from August 2009 to June 2016. All data was collected prospectively within an IRB-approved database and analysed retrospectively. Recurrences were classified as local, distant or secondary urothelial carcinomas. Kaplan-Meier and multivariate Cox regression analysis was performed. A p-value < 0.05 was considered statistically significant.
Results: Both groups were comparable with respect to age, BMI, ASA, neoadjuvant chemotherapy status, CIS, LVI, positive soft-tissue margins and node-positive disease (Table 1). RRC and ICUD patients were more likely to have an ileal conduit (64% vs 29%, p < 0.05) and extravesical disease (38% vs 30%, p < 0.05). There was no difference in recurrence-free survival for the entire cohort, and by pathological stage: organ-confined disease (pT0-pT2, n=565), extra-vesical disease (pT3-pT4, n=270) and node-positive disease (pN+, n=183, all p>0.05) [Figure 1]. Median time to recurrence was 6.9 months in RRC arm and 7.7 months in the ORC arm. On multivariable regression analysis, RRC was not an independent predictor of recurrence after adjusting for confounders (HR 1.05, 95%CI 0.75â€“1.48; p=0.8). There were no differences in the number or patterns of recurrences within 2 years, in particular, with respect to peritoneal carcinomatosis and extra-pelvic lymph node metastasis.
Conclusions: These data show no differences in the rates or patterns of local or distant recurrence between ORC and RRC. The robotic approach is not an independent predictor of recurrence after radical cystectomy for bladder cancer.