Early Oncologic Failure after Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium

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Abstract

Purpose We sought to investigate the prevalence and variables associated with early oncologic failure. Materials and Methods We retrospectively reviewed the IRCC (International Radical Cystectomy Consortium) database of patients who underwent robot-assisted radical cystectomy since 2003. The final cohort comprised a total of 1,894 patients from 23 institutions in 11 countries. Early oncologic failure was defined as any disease relapse within 3 months of robot-assisted radical cystectomy. All institutions were surveyed for the pneumoperitoneum pressure used, breach of oncologic surgical principles, and techniques of specimen and lymph node removal. A multivariate model was fit to evaluate predictors of early oncologic failure. The Kaplan-Meier method was applied to depict disease specific and overall survival, and Cox proportional regression analysis was used to evaluate predictors of disease specific and overall survival. Results A total of 305 patients (22%) experienced disease relapse, which was distant in 220 (16%), local recurrence in 154 (11%), peritoneal carcinomatosis in 17 (1%) and port site recurrence in 5 (0.4%). Early oncologic failure developed in 71 patients (5%) at a total of 10 institutions. The incidence of early oncologic failure decreased from 10% in 2006 to 6% in 2015. On multivariate analysis the presence of any complication (OR 2.87, 95% CI 1.38–5.96, p = 0.004), pT3 or greater disease (OR 3.73, 95% CI 2.00–6.97, p <0.001) and nodal involvement (OR 2.14, 95% CI 1.21–3.80, p = 0.008) was a significant predictor of early oncologic failure. Patients with early oncologic failure demonstrated worse disease specific and overall survival (23% and 13%, respectively) at 1 and 3 years compared to patients who experienced later or no recurrences (log rank p <0.001). Conclusions The incidence of early oncologic failure following robot-assisted radical cystectomy has decreased with time. Disease related rather than technical related factors have a major role in early oncologic failure after robot-assisted radical cystectomy.

Original languageEnglish
Pages (from-to)1427-1436
Number of pages10
JournalJournal of Urology
Volume197
Issue number6
DOIs
Publication statusPublished - 2017 Jun

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Cystectomy
Robotics
Recurrence
Survival
Pneumoperitoneum
Incidence
Multivariate Analysis
Lymph Nodes
Regression Analysis
Databases
Carcinoma
Pressure

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

@article{610fd552e0ad469bb7bcf1730ad9a831,
title = "Early Oncologic Failure after Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium",
abstract = "Purpose We sought to investigate the prevalence and variables associated with early oncologic failure. Materials and Methods We retrospectively reviewed the IRCC (International Radical Cystectomy Consortium) database of patients who underwent robot-assisted radical cystectomy since 2003. The final cohort comprised a total of 1,894 patients from 23 institutions in 11 countries. Early oncologic failure was defined as any disease relapse within 3 months of robot-assisted radical cystectomy. All institutions were surveyed for the pneumoperitoneum pressure used, breach of oncologic surgical principles, and techniques of specimen and lymph node removal. A multivariate model was fit to evaluate predictors of early oncologic failure. The Kaplan-Meier method was applied to depict disease specific and overall survival, and Cox proportional regression analysis was used to evaluate predictors of disease specific and overall survival. Results A total of 305 patients (22{\%}) experienced disease relapse, which was distant in 220 (16{\%}), local recurrence in 154 (11{\%}), peritoneal carcinomatosis in 17 (1{\%}) and port site recurrence in 5 (0.4{\%}). Early oncologic failure developed in 71 patients (5{\%}) at a total of 10 institutions. The incidence of early oncologic failure decreased from 10{\%} in 2006 to 6{\%} in 2015. On multivariate analysis the presence of any complication (OR 2.87, 95{\%} CI 1.38–5.96, p = 0.004), pT3 or greater disease (OR 3.73, 95{\%} CI 2.00–6.97, p <0.001) and nodal involvement (OR 2.14, 95{\%} CI 1.21–3.80, p = 0.008) was a significant predictor of early oncologic failure. Patients with early oncologic failure demonstrated worse disease specific and overall survival (23{\%} and 13{\%}, respectively) at 1 and 3 years compared to patients who experienced later or no recurrences (log rank p <0.001). Conclusions The incidence of early oncologic failure following robot-assisted radical cystectomy has decreased with time. Disease related rather than technical related factors have a major role in early oncologic failure after robot-assisted radical cystectomy.",
author = "Collaborators and Hussein, {Ahmed A.} and Matthias Saar and May, {Paul R.} and Wijburg, {Carl J.} and Lee Richstone and Andrew Wagner and Timothy Wilson and Bertram Yuh and Redorta, {Joan Palou} and Prokar Dasgupta and Khan, {Mohammad Shamim} and Mani Menon and Peabody, {James O.} and Abolfazl Hosseini and Franco Gaboardi and Alexandre Mottrie and Rha, {Koon ho} and Ashok Hemal and Michael Stockle and John Kelly and Maatman, {Thomas J.} and Canda, {Abdullah Erdem} and Peter Wiklund and Guru, {Khurshid A.} and Balbay, {Mevlana Derya} and Vassilis Poulakis and Michael Woods and Tan, {Wei Shen} and Omar Kawa and Giovannalberto Pini and Ketan Badani and Ahmed, {Youssef E.}",
year = "2017",
month = "6",
doi = "10.1016/j.juro.2016.12.048",
language = "English",
volume = "197",
pages = "1427--1436",
journal = "Journal of Urology",
issn = "0022-5347",
publisher = "Elsevier Inc.",
number = "6",

}

Early Oncologic Failure after Robot-Assisted Radical Cystectomy : Results from the International Robotic Cystectomy Consortium. / Collaborators.

In: Journal of Urology, Vol. 197, No. 6, 06.2017, p. 1427-1436.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Early Oncologic Failure after Robot-Assisted Radical Cystectomy

T2 - Results from the International Robotic Cystectomy Consortium

AU - Collaborators

AU - Hussein, Ahmed A.

AU - Saar, Matthias

AU - May, Paul R.

AU - Wijburg, Carl J.

AU - Richstone, Lee

AU - Wagner, Andrew

AU - Wilson, Timothy

AU - Yuh, Bertram

AU - Redorta, Joan Palou

AU - Dasgupta, Prokar

AU - Khan, Mohammad Shamim

AU - Menon, Mani

AU - Peabody, James O.

AU - Hosseini, Abolfazl

AU - Gaboardi, Franco

AU - Mottrie, Alexandre

AU - Rha, Koon ho

AU - Hemal, Ashok

AU - Stockle, Michael

AU - Kelly, John

AU - Maatman, Thomas J.

AU - Canda, Abdullah Erdem

AU - Wiklund, Peter

AU - Guru, Khurshid A.

AU - Balbay, Mevlana Derya

AU - Poulakis, Vassilis

AU - Woods, Michael

AU - Tan, Wei Shen

AU - Kawa, Omar

AU - Pini, Giovannalberto

AU - Badani, Ketan

AU - Ahmed, Youssef E.

PY - 2017/6

Y1 - 2017/6

N2 - Purpose We sought to investigate the prevalence and variables associated with early oncologic failure. Materials and Methods We retrospectively reviewed the IRCC (International Radical Cystectomy Consortium) database of patients who underwent robot-assisted radical cystectomy since 2003. The final cohort comprised a total of 1,894 patients from 23 institutions in 11 countries. Early oncologic failure was defined as any disease relapse within 3 months of robot-assisted radical cystectomy. All institutions were surveyed for the pneumoperitoneum pressure used, breach of oncologic surgical principles, and techniques of specimen and lymph node removal. A multivariate model was fit to evaluate predictors of early oncologic failure. The Kaplan-Meier method was applied to depict disease specific and overall survival, and Cox proportional regression analysis was used to evaluate predictors of disease specific and overall survival. Results A total of 305 patients (22%) experienced disease relapse, which was distant in 220 (16%), local recurrence in 154 (11%), peritoneal carcinomatosis in 17 (1%) and port site recurrence in 5 (0.4%). Early oncologic failure developed in 71 patients (5%) at a total of 10 institutions. The incidence of early oncologic failure decreased from 10% in 2006 to 6% in 2015. On multivariate analysis the presence of any complication (OR 2.87, 95% CI 1.38–5.96, p = 0.004), pT3 or greater disease (OR 3.73, 95% CI 2.00–6.97, p <0.001) and nodal involvement (OR 2.14, 95% CI 1.21–3.80, p = 0.008) was a significant predictor of early oncologic failure. Patients with early oncologic failure demonstrated worse disease specific and overall survival (23% and 13%, respectively) at 1 and 3 years compared to patients who experienced later or no recurrences (log rank p <0.001). Conclusions The incidence of early oncologic failure following robot-assisted radical cystectomy has decreased with time. Disease related rather than technical related factors have a major role in early oncologic failure after robot-assisted radical cystectomy.

AB - Purpose We sought to investigate the prevalence and variables associated with early oncologic failure. Materials and Methods We retrospectively reviewed the IRCC (International Radical Cystectomy Consortium) database of patients who underwent robot-assisted radical cystectomy since 2003. The final cohort comprised a total of 1,894 patients from 23 institutions in 11 countries. Early oncologic failure was defined as any disease relapse within 3 months of robot-assisted radical cystectomy. All institutions were surveyed for the pneumoperitoneum pressure used, breach of oncologic surgical principles, and techniques of specimen and lymph node removal. A multivariate model was fit to evaluate predictors of early oncologic failure. The Kaplan-Meier method was applied to depict disease specific and overall survival, and Cox proportional regression analysis was used to evaluate predictors of disease specific and overall survival. Results A total of 305 patients (22%) experienced disease relapse, which was distant in 220 (16%), local recurrence in 154 (11%), peritoneal carcinomatosis in 17 (1%) and port site recurrence in 5 (0.4%). Early oncologic failure developed in 71 patients (5%) at a total of 10 institutions. The incidence of early oncologic failure decreased from 10% in 2006 to 6% in 2015. On multivariate analysis the presence of any complication (OR 2.87, 95% CI 1.38–5.96, p = 0.004), pT3 or greater disease (OR 3.73, 95% CI 2.00–6.97, p <0.001) and nodal involvement (OR 2.14, 95% CI 1.21–3.80, p = 0.008) was a significant predictor of early oncologic failure. Patients with early oncologic failure demonstrated worse disease specific and overall survival (23% and 13%, respectively) at 1 and 3 years compared to patients who experienced later or no recurrences (log rank p <0.001). Conclusions The incidence of early oncologic failure following robot-assisted radical cystectomy has decreased with time. Disease related rather than technical related factors have a major role in early oncologic failure after robot-assisted radical cystectomy.

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U2 - 10.1016/j.juro.2016.12.048

DO - 10.1016/j.juro.2016.12.048

M3 - Article

C2 - 27993668

AN - SCOPUS:85018657616

VL - 197

SP - 1427

EP - 1436

JO - Journal of Urology

JF - Journal of Urology

SN - 0022-5347

IS - 6

ER -