Long-term oncologic outcomes following robot-assisted radical cystectomy: Results from the international robotic cystectomy consortium

Syed Johar Raza, Timothy Wilson, James O. Peabody, Peter Wiklund, Douglas S. Scherr, Ali Al-Daghmin, Shiva Dibaj, Muhammad Shamim Khan, Prokar Dasgupta, Alex Mottrie, Mani Menon, Bertram Yuh, Lee Richstone, Matthias Saar, Michael Stoeckle, Abolfazl Hosseini, Jihad Kaouk, James L. Mohler, KoonHo Rha, Gregory WildingKhurshid A. Guru

Research output: Contribution to journalArticle

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Abstract

Background Long-term oncologic data on patients undergoing robot-assisted radical cystectomy (RARC) are limited and based largely on single-institution series. Objective Report survival outcomes of patients who underwent RARC ≥5 yr ago. Design, setting, and participants Retrospective review of the prospectively populated International Robotic Cystectomy Consortium multi-institutional database identified 743 patients with RARC performed ≥5 yr ago. Clinical, pathologic, and survival data at the latest follow-up were collected. Patients with palliative RARC were excluded. Final analysis was performed on 702 patients from 11 institutions in 6 countries. Intervention RARC. Outcome measurements and statistical analysis Outcomes of interest, recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were plotted using Kaplan-Meier survival curves. A Cox proportional hazards model was used to identify factors that predicted outcomes. Results and limitations Pathologic organ-confined (OC) disease was found in 62% of patients. Soft tissue surgical margins (SMs) were positive in 8%. Median lymph node (LN) yield was 16, and 21% of patients had positive LNs. Median follow-up was 67 mo (interquartile range: 18-84 mo). Five-year RFS, CSS, and OS were 67%, 75%, and 50%, respectively. Non-OC disease and SMs were associated with poorer RFS, CSS, and OS on multivariable analysis. Age predicted poorer CSS and OS. Adjuvant chemotherapy and positive SMs were predictors of RFS (hazard ratio: 3.20 and 2.16; p < 0.001 and p < 0.005, respectively). Stratified survival curves demonstrated poorer outcomes for positive SM, LN, and non-OC disease. Retrospective interrogation and lack of contemporaneous comparison groups that underwent open radical cystectomy were major limitations. Conclusions The largest multi-institutional series to date reported long-term survival outcomes after RARC. Patient summary Patients who underwent robot-assisted radical cystectomy for bladder cancer have acceptable long-term survival.

Original languageEnglish
Pages (from-to)721-728
Number of pages8
JournalEuropean Urology
Volume68
Issue number4
DOIs
Publication statusPublished - 2015 Oct 1

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Cystectomy
Robotics
Survival
Recurrence
Neoplasms
Lymph Nodes
Kaplan-Meier Estimate
Adjuvant Chemotherapy
Proportional Hazards Models
Urinary Bladder Neoplasms

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Raza, Syed Johar ; Wilson, Timothy ; Peabody, James O. ; Wiklund, Peter ; Scherr, Douglas S. ; Al-Daghmin, Ali ; Dibaj, Shiva ; Khan, Muhammad Shamim ; Dasgupta, Prokar ; Mottrie, Alex ; Menon, Mani ; Yuh, Bertram ; Richstone, Lee ; Saar, Matthias ; Stoeckle, Michael ; Hosseini, Abolfazl ; Kaouk, Jihad ; Mohler, James L. ; Rha, KoonHo ; Wilding, Gregory ; Guru, Khurshid A. / Long-term oncologic outcomes following robot-assisted radical cystectomy : Results from the international robotic cystectomy consortium. In: European Urology. 2015 ; Vol. 68, No. 4. pp. 721-728.
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abstract = "Background Long-term oncologic data on patients undergoing robot-assisted radical cystectomy (RARC) are limited and based largely on single-institution series. Objective Report survival outcomes of patients who underwent RARC ≥5 yr ago. Design, setting, and participants Retrospective review of the prospectively populated International Robotic Cystectomy Consortium multi-institutional database identified 743 patients with RARC performed ≥5 yr ago. Clinical, pathologic, and survival data at the latest follow-up were collected. Patients with palliative RARC were excluded. Final analysis was performed on 702 patients from 11 institutions in 6 countries. Intervention RARC. Outcome measurements and statistical analysis Outcomes of interest, recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were plotted using Kaplan-Meier survival curves. A Cox proportional hazards model was used to identify factors that predicted outcomes. Results and limitations Pathologic organ-confined (OC) disease was found in 62{\%} of patients. Soft tissue surgical margins (SMs) were positive in 8{\%}. Median lymph node (LN) yield was 16, and 21{\%} of patients had positive LNs. Median follow-up was 67 mo (interquartile range: 18-84 mo). Five-year RFS, CSS, and OS were 67{\%}, 75{\%}, and 50{\%}, respectively. Non-OC disease and SMs were associated with poorer RFS, CSS, and OS on multivariable analysis. Age predicted poorer CSS and OS. Adjuvant chemotherapy and positive SMs were predictors of RFS (hazard ratio: 3.20 and 2.16; p < 0.001 and p < 0.005, respectively). Stratified survival curves demonstrated poorer outcomes for positive SM, LN, and non-OC disease. Retrospective interrogation and lack of contemporaneous comparison groups that underwent open radical cystectomy were major limitations. Conclusions The largest multi-institutional series to date reported long-term survival outcomes after RARC. Patient summary Patients who underwent robot-assisted radical cystectomy for bladder cancer have acceptable long-term survival.",
author = "Raza, {Syed Johar} and Timothy Wilson and Peabody, {James O.} and Peter Wiklund and Scherr, {Douglas S.} and Ali Al-Daghmin and Shiva Dibaj and Khan, {Muhammad Shamim} and Prokar Dasgupta and Alex Mottrie and Mani Menon and Bertram Yuh and Lee Richstone and Matthias Saar and Michael Stoeckle and Abolfazl Hosseini and Jihad Kaouk and Mohler, {James L.} and KoonHo Rha and Gregory Wilding and Guru, {Khurshid A.}",
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Raza, SJ, Wilson, T, Peabody, JO, Wiklund, P, Scherr, DS, Al-Daghmin, A, Dibaj, S, Khan, MS, Dasgupta, P, Mottrie, A, Menon, M, Yuh, B, Richstone, L, Saar, M, Stoeckle, M, Hosseini, A, Kaouk, J, Mohler, JL, Rha, K, Wilding, G & Guru, KA 2015, 'Long-term oncologic outcomes following robot-assisted radical cystectomy: Results from the international robotic cystectomy consortium', European Urology, vol. 68, no. 4, pp. 721-728. https://doi.org/10.1016/j.eururo.2015.04.021

Long-term oncologic outcomes following robot-assisted radical cystectomy : Results from the international robotic cystectomy consortium. / Raza, Syed Johar; Wilson, Timothy; Peabody, James O.; Wiklund, Peter; Scherr, Douglas S.; Al-Daghmin, Ali; Dibaj, Shiva; Khan, Muhammad Shamim; Dasgupta, Prokar; Mottrie, Alex; Menon, Mani; Yuh, Bertram; Richstone, Lee; Saar, Matthias; Stoeckle, Michael; Hosseini, Abolfazl; Kaouk, Jihad; Mohler, James L.; Rha, KoonHo; Wilding, Gregory; Guru, Khurshid A.

In: European Urology, Vol. 68, No. 4, 01.10.2015, p. 721-728.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Long-term oncologic outcomes following robot-assisted radical cystectomy

T2 - Results from the international robotic cystectomy consortium

AU - Raza, Syed Johar

AU - Wilson, Timothy

AU - Peabody, James O.

AU - Wiklund, Peter

AU - Scherr, Douglas S.

AU - Al-Daghmin, Ali

AU - Dibaj, Shiva

AU - Khan, Muhammad Shamim

AU - Dasgupta, Prokar

AU - Mottrie, Alex

AU - Menon, Mani

AU - Yuh, Bertram

AU - Richstone, Lee

AU - Saar, Matthias

AU - Stoeckle, Michael

AU - Hosseini, Abolfazl

AU - Kaouk, Jihad

AU - Mohler, James L.

AU - Rha, KoonHo

AU - Wilding, Gregory

AU - Guru, Khurshid A.

PY - 2015/10/1

Y1 - 2015/10/1

N2 - Background Long-term oncologic data on patients undergoing robot-assisted radical cystectomy (RARC) are limited and based largely on single-institution series. Objective Report survival outcomes of patients who underwent RARC ≥5 yr ago. Design, setting, and participants Retrospective review of the prospectively populated International Robotic Cystectomy Consortium multi-institutional database identified 743 patients with RARC performed ≥5 yr ago. Clinical, pathologic, and survival data at the latest follow-up were collected. Patients with palliative RARC were excluded. Final analysis was performed on 702 patients from 11 institutions in 6 countries. Intervention RARC. Outcome measurements and statistical analysis Outcomes of interest, recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were plotted using Kaplan-Meier survival curves. A Cox proportional hazards model was used to identify factors that predicted outcomes. Results and limitations Pathologic organ-confined (OC) disease was found in 62% of patients. Soft tissue surgical margins (SMs) were positive in 8%. Median lymph node (LN) yield was 16, and 21% of patients had positive LNs. Median follow-up was 67 mo (interquartile range: 18-84 mo). Five-year RFS, CSS, and OS were 67%, 75%, and 50%, respectively. Non-OC disease and SMs were associated with poorer RFS, CSS, and OS on multivariable analysis. Age predicted poorer CSS and OS. Adjuvant chemotherapy and positive SMs were predictors of RFS (hazard ratio: 3.20 and 2.16; p < 0.001 and p < 0.005, respectively). Stratified survival curves demonstrated poorer outcomes for positive SM, LN, and non-OC disease. Retrospective interrogation and lack of contemporaneous comparison groups that underwent open radical cystectomy were major limitations. Conclusions The largest multi-institutional series to date reported long-term survival outcomes after RARC. Patient summary Patients who underwent robot-assisted radical cystectomy for bladder cancer have acceptable long-term survival.

AB - Background Long-term oncologic data on patients undergoing robot-assisted radical cystectomy (RARC) are limited and based largely on single-institution series. Objective Report survival outcomes of patients who underwent RARC ≥5 yr ago. Design, setting, and participants Retrospective review of the prospectively populated International Robotic Cystectomy Consortium multi-institutional database identified 743 patients with RARC performed ≥5 yr ago. Clinical, pathologic, and survival data at the latest follow-up were collected. Patients with palliative RARC were excluded. Final analysis was performed on 702 patients from 11 institutions in 6 countries. Intervention RARC. Outcome measurements and statistical analysis Outcomes of interest, recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were plotted using Kaplan-Meier survival curves. A Cox proportional hazards model was used to identify factors that predicted outcomes. Results and limitations Pathologic organ-confined (OC) disease was found in 62% of patients. Soft tissue surgical margins (SMs) were positive in 8%. Median lymph node (LN) yield was 16, and 21% of patients had positive LNs. Median follow-up was 67 mo (interquartile range: 18-84 mo). Five-year RFS, CSS, and OS were 67%, 75%, and 50%, respectively. Non-OC disease and SMs were associated with poorer RFS, CSS, and OS on multivariable analysis. Age predicted poorer CSS and OS. Adjuvant chemotherapy and positive SMs were predictors of RFS (hazard ratio: 3.20 and 2.16; p < 0.001 and p < 0.005, respectively). Stratified survival curves demonstrated poorer outcomes for positive SM, LN, and non-OC disease. Retrospective interrogation and lack of contemporaneous comparison groups that underwent open radical cystectomy were major limitations. Conclusions The largest multi-institutional series to date reported long-term survival outcomes after RARC. Patient summary Patients who underwent robot-assisted radical cystectomy for bladder cancer have acceptable long-term survival.

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