Presentation Authors: Eric Gourley*, Hanzhang Wang, Arpan Satsangi, Karen Wheeler, Dharam Kaushik, Michael Liss, Robert Svatek, Ahmed M Mansour, San Antonio, TX
Introduction: Robot-assisted laparoscopic radical cystectomy (RARC) has evolved as a reproducible minimally invasive alternative to open radical cystectomy (ORC) with non-inferior oncologic outcomes. Concerns have been raised that offering RARC was associated with deprivation of patients from continent urinary diversion (CUD). We aimed to evaluate contemporary practice patterns in radical cystectomy and urinary diversion.
Methods: We investigated the National Cancer Database (NCDB) for patients with localized MIBC clinical stage cT2-T4M0 who underwent radical cystectomy (RC) . Utilization trends of ORC, RARC, CUD and ileal conduit urinary diversion (ICUD) were analyzed. Multivariable logistic regression models were fitted to asses factors associated with adoption of RARC and CUD.
Results: A total of 14,466 RCs were performed from 2010 to 2015. Of these, 9,356 (64.68%) were ORC and 4,914 (33.97%) were RARC. _x000D_
There was a significant increase in adoption of RARC from (10.72%) in 2010 to (20.86%) in 2015 (r2=0.9660 , p < 0.001) ( Figure 1). _x000D_
Across all years ICUD was the primary mode of urinary diversion, CUD was only offered in 2.70 % in 2010 compared to 2.06 % in 2015 (r2=0.330, p=0.223). Among patients who underwent RARC only 2.44% received CUD, a similar proportion was noted in ORC group 2.66%. _x000D_
Multivariate analysis identified male gender, age lower than 60, surgery at academic center, and T2 stage as independent predictors of receiving CUD. Similarly, later year of diagnosis, male gender and T2 stage, were independent predictors of receipt of RARC. _x000D_
Conversion from RARC to ORC occurred in 3.8% of cases, later year of diagnosis was associated with decreased risk of open conversion (2015 vs 2010 OR : 0.31, 95% CI 0.19-0.52 p < 0.001).
Conclusions: There is a significant nationwide increasing trend of adoption of MIRC. This diffusion was not associated with decline in CUD which remains significantly underutilized in both open and minimally invasive groups.