Clinical outcome of laparoscopic versus robot-assisted radical cystectomy for patients with bladder cancer: a retrospective study

Abstract Background With the development of minimally invasive surgery technology, patients with bladder cancer are increasingly receiving laparoscopic radical cystectomy (LRC) or robotic-assisted radical cystectomy (RARC) treatment. The main purpose of this study was to compare the long-term outcomes of bladder cancer patients treated with LRC versus RARC. Methods A retrospective study to identify patients with clinical stage Ta/T1/Tis to T3 bladder cancer who underwent RARC or LRC has been performed. The perioperative outcome, recurrence, and overall survival (OS) of the two surgical methods were compared. Results 218 patients were identified from March 2010 to December 2019 in our department, which including 82 (38%) patients who received LRC and 136 (62%) patients who received RARC. There was no significant difference between the two groups in terms of lymph node collection, lymph node positive rate, resection margin positive rate, and postoperative pathological staging. Compared with the LRC group, patients in the RARC group had a median estimated blood loss (180 vs. 250 ml; P = 0.02) and reduced complications at 90 days postoperatively (30.8% vs. 46.3%; P = 0.01). Recurrence, all-cause death, and cancer-specific death occurred in 77 (35%), 55 (25%), and 39 (18%) patients, respectively. The 5-year OS rate was 54.63% and 54.65% in the RARC and LRC group (P > 0.05). The 5-year cancer-specific survival (CSS) rate was 73.32% and 61.55% in RARC and LRC group (P > 0.05). There was no significant difference in OS [hazard ratio (HR) 1.083, 95% confidence interval (CI) 0.626–1.874; P = 0.78], and CSS (HR 0.789, 95%CI 0.411–1.515; P = 0.61) between two groups. Conclusions Both RARC and LRC were safe and effective with a similar long-term clinical outcomes. Moreover, RARC had significantly lower median estimated blood loss and reduced postoperative complications.

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Clinical outcome of Laparoscopic and Robot-assisted Radical Cystectomy for Bladder Cancer in a Retrospective Study

10.21203/rs.3.rs-517351/v1 ◽

2021 ◽

Author(s):

YuChen Bai ◽

Shuai Wang ◽

Wei Zheng ◽

Jing Quan ◽

Fei Wei ◽

...

Keyword(s):

Bladder Cancer ◽

Retrospective Study ◽

Postoperative Complications ◽

Blood Loss ◽

Radical Cystectomy ◽

Perioperative Outcomes ◽

Robot Assisted ◽

Long Term Outcome ◽

Estimated Blood Loss

Abstract Background: With the rapid development of surgical technics and instruments, more and more bladder cancer patients are being treated by laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) .The aim of this retrospective study was to compare the perioperative and long-term outcomes of patients who underwent cystectomy by these two surgical approaches. Methods: We performed a retrospective review of the prospectively collected database of our hospital to identify patients with clinical stage Ta/T1/Tis to T3 who underwent RARC and LRC. Perioperative outcomes, recurrence, and overall survival (OS) were analyzed. Results: From March 2010 to December 2019, there were total of 218 patients, which including 82(38%) patients with LRC and 136(62%) patients with RARC. No perioperative death was observed in both groups. Tumor recurrence, death from any causes, and cancer-specific death occurred in 77, 55, and 39 patients respectively. The 5-year DFS, OS, and CSS rates for all included patients were 55.4%, 62.4%, and 66.4%, respectively. There were no significantly statistically differences between the RARC group and the LRC group for number of lymph nodes harvested, positive lymph node rate, positive margin rate and postoperative pathological stage (all P>0.05). Patients undergoing RARC had lower median estimated blood loss (180mL vs. 250 mL; P 0.015) and 90-days postoperative complications (30.8% vs. 46.3%; P 0.013) than LRC.Conclusions: For selected patients with RARC and LRC, both were safe and effective with a low complication rate and similar long-term outcome compared two groups. Moreover, the robotic approach resulted in lower median estimated blood loss and better outcome in postoperative complications.

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Radical Cystectomy in the Treatment of Invasive Bladder Cancer: Long-Term Results in 1,054 Patients

Journal of Clinical Oncology ◽

10.1200/jco.2001.19.3.666 ◽

2001 ◽

Vol 19 (3) ◽

pp. 666-675 ◽

Cited By ~ 2332

Author(s):

John P. Stein ◽

Gary Lieskovsky ◽

Richard Cote ◽

Susan Groshen ◽

An-Chen Feng ◽

...

Keyword(s):

Bladder Cancer ◽

Lymph Node ◽

Radical Cystectomy ◽

Bladder Tumor ◽

Invasive Bladder Cancer ◽

Recurrence Free Survival ◽

Free Survival ◽

Node Negative ◽

Primary Bladder

PURPOSE: To evaluate our long-term experience with patients treated uniformly with radical cystectomy and pelvic lymph node dissection for invasive bladder cancer and to describe the association of the primary bladder tumor stage and regional lymph node status with clinical outcomes. PATIENTS AND METHODS: All patients undergoing radical cystectomy with bilateral pelvic iliac lymphadenectomy, with the intent to cure, for transitional-cell carcinoma of the bladder between July 1971 and December 1997, with or without adjuvant radiation or chemotherapy, were evaluated. The clinical course, pathologic characteristics, and long-term clinical outcomes were evaluated in this group of patients. RESULTS: A total of 1,054 patients (843 men [80%] and 211 women) with a median age of 66 years (range, 22 to 93 years) were uniformly treated. Median follow-up was 10.2 years (range, 0 to 28 years). There were 27 (2.5%) perioperative deaths, with a total of 292 (28%) early complications. Overall recurrence-free survival at 5 and 10 years for the entire cohort was 68% and 66%, respectively. The 5- and 10-year recurrence-free survival for patients with organ-confined, lymph node–negative tumors was 92% and 86% for P0 disease, 91% and 89% for Pis, 79% and 74% for Pa, and 83% and 78% for P1 tumors, respectively. Patients with muscle invasive (P2 and P3a), lymph node–negative tumors had 89% and 87% and 78% and 76% 5- and 10-year recurrence-free survival, respectively. Patients with nonorgan-confined (P3b, P4), lymph node–negative tumors demonstrated a significantly higher probability of recurrence compared with those with organ-confined bladder cancers (P < .001). The 5- and 10-year recurrence-free survival for P3b tumors was 62% and 61%, and for P4 tumors was 50% and 45% , respectively. A total of 246 patients (24%) had lymph node tumor involvement. The 5- and 10-year recurrence-free survival for these patients was 35%, and 34%, respectively, which was significantly lower than for patients without lymph node involvement (P < .001). Patients could also be stratified by the number of lymph nodes involved and by the extent of the primary bladder tumor (p stage). Patients with fewer than five positive lymph nodes, and whose p stage was organ-confined had significantly improved survival rates. Bladder cancer recurred in 311 patients (30%) . The median time to recurrence among those patients in whom the cancer recurred was 12 months (range, 0.04 to 11.1 years). In 234 patients (22%) there was a distant recurrence, and in 77 patients (7%) there was a local (pelvic) recurrence. CONCLUSION: These data from a large group of patients support the aggressive surgical management of invasive bladder cancer. Excellent long-term survival can be achieved with a low incidence of pelvic recurrence.

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The long-term efficacy of one-shot neoadjuvant intra-arterial chemotherapy combined with radical cystectomy versus radical cystectomy alone for bladder cancer: a propensity-score matching study

BMC Urology ◽

10.1186/s12894-019-0552-7 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

Wasilijiang Wahafu ◽

Sai Liu ◽

Wenbin Xu ◽

Mengtong Wang ◽

Qingbao He ◽

...

Keyword(s):

Bladder Cancer ◽

Propensity Score ◽

Propensity Score Matching ◽

Radical Cystectomy ◽

Survival Outcomes ◽

High Morbidity ◽

Term Efficacy ◽

Tumor Stages ◽

Significant Difference

Abstract Background Bladder cancer is a complex disease associated with high morbidity and mortality. Management of bladder cancer before radical cystectomy continues to be controversial. We compared the long-term efficacy of one-shot neoadjuvant intra-arterial chemotherapy (IAC) versus no IAC (NIAC) before radical cystectomy (RC) for bladder cancer. Methods We performed a retrospective review of patients who underwent either one-shot IAC or NIAC before RC between October 2006 and November 2015. A propensity-score matching (1:3) was performed based on key characters. The Kaplan-Meier method was utilized to estimate survival probabilities, and the log-rank test was used to compare survival outcomes between different groups. A multivariable Cox proportional hazard model was used to estimate survival outcomes. Results Twenty-six patients were treated using IAC before RC, and 123 NIAC patients also underwent RC. After matching, there was no significant difference between groups in baseline characteristics, perioperative variables, complication outcomes or tumor characteristics. Compared with clinical tumor stages, pathological tumor stages demonstrated a significant decrease (P = 0.002) in the IAC group. There was no significant difference in overall survival (OS, p = 0.354) or cancer-specific survival (CSS, p = 0.439) between the groups. Among all patients, BMI significantly affected OS (p = 0.004), and positive lymph nodes (PLN) significantly affected both OS (p<0.001) and CSS (p = 0.010). Conclusions One-shot neoadjuvant IAC before RC shows safety and tolerability and provides a significant advantage in pathological downstaging but not in OS or CSS. Further study of neoadjuvant combination therapeutic strategies with RC is needed.

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The long-term efficacy of one-shot neoadjuvant intra-arterial chemotherapy combined with radical cystectomy versus radical cystectomy alone for bladder cancer: a propensity-score matching study

10.21203/rs.2.11853/v4 ◽

2019 ◽

Author(s):

Wasilijiang Wahafu ◽

Sai Liu ◽

Wenbin Xu ◽

Mengtong Wang ◽

Qingbao He ◽

...

Keyword(s):

Bladder Cancer ◽

Propensity Score ◽

Propensity Score Matching ◽

Radical Cystectomy ◽

Survival Outcomes ◽

High Morbidity ◽

Term Efficacy ◽

Tumor Stages ◽

Significant Difference

Abstract Background: Bladder cancer is a complex disease associated with high morbidity and mortality. Management of bladder cancer before radical cystectomy continues to be controversial. We compared the long-term efficacy of one-shot neoadjuvant intra-arterial chemotherapy (IAC)versus no IAC (NIAC) before radical cystectomy (RC) for bladder cancer. Methods: We performed a retrospective review of patients who underwent either one-shot IAC or NIAC before RC between October 2006 and November 2015. A propensity-score matching (1:3) was performed based on key characters. The Kaplan-Meier method was utilized to estimate survival probabilities, and the log-rank test was used to compare survival outcomes between different groups. A multivariable Cox proportional hazard model was used to estimate survival outcomes. Results: Twenty-six patients were treated using IAC before RC, and 123 NIAC patients also underwent RC. After matching, there was no significant difference between groups in baseline characteristics, perioperative variables, complication outcomes or tumor characteristics. Compared with clinical tumor stages, pathological tumor stages demonstrated a significant decrease (P=0.002) in the IAC group. There was no significant difference in overall survival (OS, p=0.354) or cancer-specific survival (CSS, p=0.439) between the groups. Among all patients, BMI significantly affected OS (p=0.004), and positive lymph nodes (PLN) significantly affected both OS (p＜0.001) and CSS(p=0.010). Conclusions: One-shot neoadjuvant IAC before RC shows safety and tolerability and provides a significant advantage in pathological downstaging but not in OS or CSS. Further study of neoadjuvant combination therapeutic strategies with RC is needed.

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The long-term efficacy of one-shot neoadjuvant intra-arterial chemotherapy combined with radical cystectomy versus radical cystectomy alone for bladder cancer: a propensity-score matching study

10.21203/rs.2.11853/v3 ◽

2019 ◽

Author(s):

Wasilijiang Wahafu ◽

Sai Liu ◽

Wenbin Xu ◽

Mengtong Wang ◽

Qingbao He ◽

...

Keyword(s):

Bladder Cancer ◽

Propensity Score ◽

Propensity Score Matching ◽

Radical Cystectomy ◽

Rank Test ◽

Survival Outcomes ◽

High Morbidity ◽

Term Efficacy ◽

Significant Difference

Abstract Background: Bladder cancer is a complex disease associated with high morbidity and mortality. The management of bladder cancer before radical cystectomy continues to be controversial. We compared the long-term efficacy of one-shot neoadjuvant intra-arterial chemotherapy (IAC)versus no IAC (NIAC) before radical cystectomy (RC) for bladder cancer. Methods: We performed a retrospective review of patients who underwent either one-shot IAC or NIAC before RC between October 2006 and November 2015. Propensity-score matching (1:3) was performed based on key characteristics. The Kaplan-Meier method was utilized to estimate survival probabilities, and the log-rank test was used to compare survival outcomes between different groups. A multivariable Cox proportional hazards model was used to estimate survival outcomes. Results: Twenty-six patients were treated using IAC before RC, and 123 NIAC patients also underwent RC. After matching, there was no significant difference between the groups in baseline characteristics, perioperative variables, complication outcomes or tumour characteristics. Compared with the clinical tumour stages, the pathological tumour stages demonstrated a significant decrease (P=0.002) in the IAC group. There was no significant difference in overall survival (OS, p=0.354) or cancer-specific survival (CSS, p=0.439) between the groups. Among all patients, BMI significantly affected OS (p=0.004), and positive lymph nodes (PLN) significantly affected both OS(p＜0.001) and CSS (p=0.010). Conclusions: One-shot neoadjuvant IAC before RC shows safety and tolerability and provides a significant advantage in pathological downstaging but not in OS or CSS. Further study of neoadjuvant combination therapeutic strategies with RC is needed.

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The long-term efficacy of one-shot neoadjuvant intra-arterial chemotherapy combined with radical cystectomy versus radical cystectomy alone for bladder cancer: a propensity-score matching study

10.21203/rs.2.11853/v1 ◽

2019 ◽

Author(s):

Wasilijiang Wahafu ◽

Sai Liu ◽

Wenbin Xu ◽

Mengtong Wang ◽

Qingbao He ◽

...

Keyword(s):

Bladder Cancer ◽

Propensity Score ◽

Propensity Score Matching ◽

Radical Cystectomy ◽

Survival Outcomes ◽

High Morbidity ◽

Term Efficacy ◽

Tumor Stages ◽

Significant Difference

Abstract Background: Bladder cancer is a complex disease associated with high morbidity and mortality. Management of bladder cancer before radical cystectomy continues to be controversial. We compared the long-term efficacy of one-shot neoadjuvant intra-arterial chemotherapy (IAC) versus no IAC (NIAC) before radical cystectomy (RC) for bladder cancer. Methods: We performed a retrospective review of patients who underwent either one-shot IAC or NIAC before RC between October 2006 and November 2015. A propensity-score matching (1:3) was performed based on key characters. The Kaplan-Meier method was utilized to estimate survival probabilities, and the log-rank test was used to compare survival outcomes between different groups. A multivariable Cox proportional hazard model was used to estimate survival outcomes. Results: Twenty-six patients were treated using IAC before RC, and 123 NIAC patients also underwent RC. After matching, there was no significant difference between groups in baseline characteristics, perioperative variables, complication outcomes or tumor characteristics. Compared with clinical tumor stages, pathological tumor stages demonstrated a significant decrease (P=0.002) in the IAC group. There was no significant difference in overall survival (OS, p=0.354) or cancer-specific survival (CSS, p=0.439) between the groups. Among all patients and in the NIAC group, BMI significantly affected OS (p=0.004 and p=0.014, respectively), and positive lymph nodes significantly affected both OS (p＜0.001, both) and CSS (p=0.010 and p=0.017, respectively). Only diabetes involvement at the time of IAC was significantly associated with worse overall mortality (p=0.004). Conclusions: One-shot neoadjuvant IAC before RC shows safety and tolerability and provides a significant advantage in pathological downstaging but not in OS or CSS. Further study of neoadjuvant combination therapeutic strategies with RC is needed.

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Peri-Operative Outcomes after Open and Robot-Assisted Radical Cystectomy by Using an Advanced Bipolar Seal and Cut Technology (Caiman®): A Prospective, Comparative, and Multi-Institutional Study

Current Urology ◽

10.1159/000489421 ◽

2018 ◽

Vol 12 (2) ◽

pp. 64-69 ◽

Cited By ~ 4

Author(s):

Marco Borghesi ◽

Riccardo Schiavina ◽

Alessandro Antonelli ◽

Carlo Buizza ◽

Antonio Celia ◽

...

Keyword(s):

Length Of Stay ◽

Blood Loss ◽

Radical Cystectomy ◽

Operative Time ◽

Length Of Hospital Stay ◽

Transfusion Rate ◽

Robot Assisted ◽

Operative Outcomes ◽

Estimated Blood Loss ◽

Significant Difference

Objective: To report and compare the peri-operative outcomes of patients undergoing open (ORC) and robotic-assisted radical cystectomy (RARC) for bladder cancer performed with a radiofrequency seal and cut device (Caiman®). Materials and Methods: Data of patients undergoing ORC or RARC between January 2015 and March 2016 at 6 Italian institutions were prospectively recorded and analyzed. Thirty-and 90-day complications were stratified according to the Martin's criteria and graded according to the Clavien-Dindo classification. Data on operative time, blood loss, transfusion rate, complications, and length of stay were evaluated and compared between the ORC and RARC groups. Results: Thirty-three (66%) and 17 (34%) patients were treated with ORC and RARC, respectively. The median age was 72 (64-78) years. Overall operative time was longer in RARC compared to ORC (389 ± 80.1 vs. 242 ± 62.2 min, p < 0.001), while the estimated blood loss during cystectomy was higher after ORC (370 ± 126.8 vs. 243.3 ± 201.6 ml, p = 0.03). The transfusion rate was significantly higher in the ORC compared to RARC (24.2 vs. 5.9%, p = 0.04). Eight (19%) and 7 (16.7%) patients experienced 30- and 90-day post-operative complications, with no significant difference between ORC and RARC. Length of stay was significantly shorter in RARC group (median 7 vs. 14 days, p < 0.001). Conclusion: Open and robot-assisted procedures were safely performed by using a new advanced bipolar seal and cut technology (Caiman®). RARC demonstrated to be superior to ORC in terms of bleeding, transfusion rates and length of hospital stay, despite longer operative time.

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PD31-07 DIFFERENCES IN LYMPH NODE COUNT AT RADICAL CYSTECTOMY WITH A STANDARDIZED SURGICAL TEMPLATE DO NOT INFLUENCE LONG-TERM SURVIVAL FOR BLADDER CANCER

The Journal of Urology ◽

10.1016/j.juro.2015.02.2092 ◽

2015 ◽

Vol 193 (4S) ◽

Author(s):

Elisabeth E. Fransen van de Putte ◽

Tom J.N. Hermans ◽

Erik van Werkhoven ◽

Laura S. Mertens ◽

Richard P. Meijer ◽

...

Keyword(s):

Bladder Cancer ◽

Lymph Node ◽

Radical Cystectomy ◽

Term Survival ◽

Long Term Survival ◽

Lymph Node Count ◽

Surgical Template ◽

Node Count

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The long-term efficacy of one-shot neoadjuvant intra-arterial chemotherapy combined with radical cystectomy versus radical cystectomy alone for bladder cancer: a propensity-score matching study

10.21203/rs.2.11853/v2 ◽

2019 ◽

Author(s):

Wasilijiang Wahafu ◽

Sai Liu ◽

Wenbin Xu ◽

Mengtong Wang ◽

Qingbao He ◽

...

Keyword(s):

Bladder Cancer ◽

Propensity Score ◽

Propensity Score Matching ◽

Radical Cystectomy ◽

Rank Test ◽

Survival Outcomes ◽

High Morbidity ◽

Term Efficacy ◽

Significant Difference

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Modified Ileal Conduit for Urinary Diversion After Radical Cystectomy: Perioperative and Oncological Outcomes

10.21203/rs.3.rs-230339/v1 ◽

2021 ◽

Author(s):

Yimu Zhang ◽

Jing Li ◽

Jiyan Bai ◽

Zhengyu Zhou ◽

Pei Tian ◽

...

Keyword(s):

Bladder Cancer ◽

Lymph Node ◽

Radical Cystectomy ◽

Influencing Factors ◽

Cox Regression ◽

Ileal Conduit ◽

Demographic Data ◽

Lymph Node Involvement ◽

Oncological Outcomes ◽

Estimated Blood Loss

Abstract Background: To evaluate the surgical effects and oncological outcomes of modified ileal conduit (IC) after radical cystectomy (RC) for bladder cancer.Methods: A single-centre cohort of 211 consecutive bladder cancer patients who underwent RC + modified IC from September 2012 to August 2019 were retrospectively studied. Demographic data, perioperative results, complications 30 and 90 days after surgery and oncological outcomes were recorded. Kaplan–Meier method was used to plot the stage-specific survival results. The 5-year recurrence-free survival (RFS）and overall survival (OS) rate was calculated. Univariate and multivariate Cox regression analyses assessed the predictive risk factors on survival rate.Results: Overall, 211 patients received modified IC after RC. The median operative time (OT) was 315 minutes (IQR, 260–375 minutes), and the median estimated blood loss (EBL) was 500 ml (IQR, 300–900 ml). There were a total of 103 (48.8%) complications. There were 35, 54, 11, and 2 cases of grade I, II, III, and IV complications, respectively; of which 89 cases were grade I and II, accounting for 87.3% of total cases. There were 38 cases of preoperative hydronephrosis and 22 cases of postoperative hydronephrosis. There were 19, 24, 108, 40, and 20 cases of PT0, T1, T2, T3, and T4, respectively, in postoperative pathological stages. The median lymphadenectomy was 14 (IQR, 6–18), and lymph node was found positive in 18 patients. The median follow-up time was 26 months (IQR, 13–43), with a total survival of 177 (83.9%), an RFS of 171 (81%), and 34 deaths. The estimated 5-year OS and RFS rates were 76.80% and 79.10%. Preoperative comorbidities, pathological stage, grade, and lymph node involvement were important influencing factors for OS, while preoperative comorbidities and high pathological grade were important influencing factors for RFS.Conclusions: Modified IC after RC not only can achieve lower postoperative complications, especially the lower incidence of uretero-ileal anastomosis and stoma-related complications but can also achieve the established oncological outcomes of critical radical surgery.

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