Presentation Authors: Stefania Zamboni*, Lucerne, Switzerland, Francesco Soria, Romain Mathieu, Vienna, Austria, Evanguelos Xylinas, Paris, France, David D`Andrea, Mohammad Abufaraj, Vienna, Austria, Wei Shen Tan, John D. Kelly, London, United Kingdom, Giuseppe Simone, Michele Gallucci, Rome, Italy, Anoop Meraney, Hartford, CT, Suprita Krishna, Badrinath Konety, Minneapolis, MN, Francesco Montorsi, Alberto Briganti, Milan, Italy, Agostino Mattei, Philipp Baumeister, Lucerne, Switzerland, Alessandro Antonelli, Claudio Simeone, Brescia, Italy, Michael Rink, Hamburg, Germany, Atiqullah Aziz, Rostock, Germany, Pierre I Karakiewicz, Montreal, Canada, Morgan Rouprêt, Paris, France, Matt Perry, London, United Kingdom, Edward Rowe, Anthony Koupparis, Bristol, United Kingdom, Douglas S Scherr, New York, NY, Guillaume Ploussard, Toulouse, France, Prasanna Sooriakumaran, London, United Kingdom, Shahrokh F. Shariat, Marco Moschini, Vienna, Austria
Introduction: In the last 15 years robotic surgery became the leading approach for treatment of prostate and kidney cancer. Following the success of these procedures, robotic system has been more recently applied to treat bladder cancer (BCa) but sparse data exists regarding the diffusion of robotic radical cystectomy (RARC) and its trend in contemporary patients. Aim of our study is comparing utilization trends and time-changes in perioperative outcomes of RARC using data from a large multicenter collaboration.
Methods: We retrospectively evaluated data from 2,713 patients treated with open radical cystectomy (ORC) and RARC for BCa at 16 American and European institutions between 2006 and 2018. All patients had completed data regarding pre-, intra- e post-operative characteristics. The Kruskal-Wallis test and Chi-square test evaluated differences between continuous and categorical variables, respectively.
Results: Overall, 971 (36%) patients underwent RARC and 1,705 (64%) ORC. RARC became the most commonly performed procedure in contemporary patients, with an increase from 14% in 2006-2007 to 58% in 2016-2018 (p < 0.001). Patients who underwent RARC were younger than those treated with ORC (median 67 years [IQR: 58-78] vs 68 [IQR: 62-75], p < 0.001) and percentage of male was higher (82% vs 79%, p=0.015). Patients who underwent RARC had less advanced T stages (pTâ‰¤2: RARC vs ORC, 62 % vs 50%, p < 0.001) and lymph node (LN) invasion (23% vs 32%, p < 0.001). Despite no significant differences in operation time (RARC vs ORC, median 360 min [IQR 300-425] vs. 360 min [300-420], p=0.3) patients treated with RARC had more LN removed (median 19 [IQR 12-27] vs 17 [IQR 10-24], p=0.001). Blood loss was significantly lower for RARC (400 ml [IQR 200-600] vs 800 [IQR 500-1300], p=0.001) as well as length of stay (9 days [IQR 7-12] vs 19 [IQR 13-26], p=0.001). No differences were found in early reoperation rates (p=0.1) or perioperative mortality (p=0.6). Patients treated with RARC were more likely to be readmitted (19% vs 13%, p=0.002). All perioperative outcomes remained stable over the study period.
Conclusions: The use of RARC is constantly increasing overtaking at these selected centers, ORC. In the last decade perioperative outcomes remained substantially unchanged. We confirmed the lower blood loss and shorter length of stay of RARC compared to ORC. Studies need to reveal whether these quality criteria translate into sustainable long-term quality and quantity of life benefits.