Intermediate-term survival of robot-assisted versus open radical cystectomy for muscle-invasive and high-risk non-muscle invasive bladder cancer in The Netherlands

•Patients with favorable prognostic factors are selected for robot-assisted surgery.•Open and robot-assisted radical cystectomy show similar survival outcomes.•This study supports 5years oncological safety of robot-assisted radical cystectomy. Radical cystectomy with pelvic lymph node dissection is...

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Published in:	Urologic oncology Vol. 40; no. 2; pp. 60.e1 - 60.e9
Main Authors:	Hinsenveld, Florentien J., Boormans, Joost L, van der Poel, Henk G, van der Schoot, Deric K E, Vis, André N, Aben, Katja K H, Arends, TJ, Ausems, PJ, Baselmans, D, Berger, CPAM, Berrens, A, Bickerstaffe, H, Bos, SD, Braam, M, Buddingh, KT, Claus, S, Dekker, K, van Doeveren, T, Einerhand, SMH, Fossion, LMCL, van Gennep, EJ, van Ginkel, N, Palacios, LA Grondhuis, Hermans, TJN, Hobijn, MM, van Huystee, SH, Jaspers-Valentijn, M, Klaver, OS, Koldewijn, EL, Korsten, L, Lenting, A, Lentjes, KJ, Luiting, HB, van der Meer, S., Nieuwenhuijzen, JA, Noordzij, MA, Nooter, RI, Notenboom, CAW, Oomen, RJA, van Roermund, JGH, de Rooij, J, Roshani, H, Schrier, BP, van der Slot, MA, Somford, DM, Stelwagen, PJ, Stroux, AMA, van der West, A, Wijsman, BP, Windt, WAKM, van Zanten, P, van Beek, Sytse C
Format:	Journal Article
Language:	English
Published:	United States Elsevier Inc 01-02-2022
Subjects:	Aged Bladder cancer Cystectomy Cystectomy - methods Female Humans Male Muscle invasive Netherlands Retrospective Studies Robot Robotic Surgical Procedures - methods Robotics - methods Survival Survival Analysis Urinary Bladder Neoplasms - mortality Urinary Bladder Neoplasms - pathology Urinary Bladder Neoplasms - surgery Netherlands ORC RCT NMIBC CI RARC CCI STROBE HR IQR Bladder cancer Survival ASA CT Cystectomy PALGA MIBC Muscle invasive NCR Robot PET BMI
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Summary:	•Patients with favorable prognostic factors are selected for robot-assisted surgery.•Open and robot-assisted radical cystectomy show similar survival outcomes.•This study supports 5years oncological safety of robot-assisted radical cystectomy. Radical cystectomy with pelvic lymph node dissection is the recommended treatment in non-metastatic muscle-invasive bladder cancer (MIBC). In randomised trials, robot-assisted radical cystectomy (RARC) showed non-inferior short-term oncological outcomes compared with open radical cystectomy (ORC). Data on intermediate and long-term oncological outcomes of RARC are limited. To assess the intermediate-term overall survival (OS) and recurrence-free survival (RFS) of patients with MIBC and high-risk non-MIBC (NMIBC) who underwent ORC versus RARC in clinical practice. A nationwide retrospective study in 19 Dutch hospitals including patients with MIBC and high-risk NMIBC treated by ORC (n = 1086) or RARC (n = 386) between January 1, 2012 and December 31, 2015. Primary and secondary outcome measures were median OS and RFS, respectively. Survival outcomes were estimated using Kaplan-Meier curves. A multivariable Cox regression model was developed to adjust for possible confounders and to assess prognostic factors for survival including clinical variables, clinical and pathological disease stage, neoadjuvant therapy and surgical margin status. The median follow-up was 5.1 years (95% confidence interval ([95%CI] 5.0–5.2). The median OS after ORC was 5.0 years (95%CI 4.3–5.6) versus 5.8 years after RARC (95%CI 5.1–6.5). The median RFS was 3.8 years (95%CI 3.1–4.5) after ORC versus 5.0 years after RARC (95%CI 3.9–6.0). After multivariable adjustment, the hazard ratio for OS was 1.00 (95%CI 0.84–1.20) and for RFS 1.08 (95%CI 0.91–1.27) of ORC versus RARC. Patients who underwent ORC were older, had higher preoperative serum creatinine levels and more advanced clinical and pathological disease stage. ORC and RARC resulted in similar intermediate-term OS and RFS in a cohort of almost 1500 MIBC and high-risk NMIBC. [Display omitted]
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1078-1439 1873-2496
DOI:	10.1016/j.urolonc.2021.06.018