Efficacy of robot-assisted radical cystectomy (RARC) in advanced bladder cancer: results from the International Radical Cystectomy Consortium (IRCC)
Por:
Al-Daghmin, A, Kauffman, EC, Shi, Y, Badani, K, Balbay, MD, Canda, E, Dasgupta, P, Ghavamian, R, Grubb, R, Hemal, A, Kaouk, J, Kibel, AS, Maatman, T, Menon, M, Mottrie, A, Nepple, K, Pattaras, JG, Peabody, JO, Poulakis, V, Pruthi, R, Redorta, JP, Rha, KH, Richstone, L, Schanne, F, Scherr, DS, Siemer, S, Stockle, M, Wallen, EM, Weizer, A, Wiklund, P, Wilson, T, Wilding, G, Woods, M, Guru, KA
Publicada:
1 jul 2014
Resumen:
Objective
To characterise the surgical feasibility and outcomes of robot-assisted radical cystectomy (RARC) for pathological T4 bladder cancer.
Patients and Methods
Retrospective evaluation of a prospectively maintained International Radical Cystectomy Consortium database was conducted for 1118 patients who underwent RARC between 2003 and 2012.
We dichotomised patients based on pathological stage (<= pT3 vs pT4) and evaluated demographic, operative and pathological variables in relation to morbidity and mortality.
Results
In all, 1000 <= pT3 and 118 pT4 patients were evaluated. The pT4 patients were older than the <= pT3 patients (P = 0.001).
The median operating time and blood loss were 386 min and 350 mL vs 396 min and 350 mL for p T4 and <= pT3, respectively.
The complication rate was similar (54% vs 58%; P = 0.64) among <= pT3 and pT4 patients, respectively. The overall 30- and 90-day mortality rate was 0.4% and 1.8% vs 4.2% and 8.5% for <= pT3 vs pT4 patients (P < 0.001), respectively.
The body mass index (BMI), American Society of Anesthesiology score, length of hospital stay (LOS) >10 days, and 90-day readmission were significantly associated with complications in pT4 patients.
Meanwhile, BMI, LOS > 10 days, grade 3-5 complications, 90-day readmission, smoking, previous abdominal surgery and neoadjuvant chemotherapy were significantly associated with mortality in pT4 patients. On multivariate analysis, BMI was an independent predictor of complications in pT4 patients, but not for mortality.
Conclusions
RARC for pT4 bladder cancer is surgically feasible but entails significant morbidity and mortality.
BMI was independent predictor of complications in pT4 patients.
Filiaciones:
Al-Daghmin, A:
Roswell Pk Canc Inst, Buffalo, NY 14263 USA
Kauffman, EC:
Roswell Pk Canc Inst, Buffalo, NY 14263 USA
Shi, Y:
Roswell Pk Canc Inst, Buffalo, NY 14263 USA
Badani, K:
Columbia Univ, Med Ctr, New York, NY USA
Balbay, MD:
Mem Sisli Hosp, Istanbul, Turkey
Canda, E:
Ankara Ataturk Training & Res Hosp, Ankara, Turkey
Dasgupta, P:
Kings Coll London, MRC Ctr Transplantat, London WC2R 2LS, England
Guys Hosp, Dept Urol, London SE1 9RT, England
Ghavamian, R:
UN Hosp Albert Einstein Coll Med, Montefiore Med Ctr, Bronx, NY USA
Grubb, R:
Washington Univ, Sch Med, St Louis, MO USA
Hemal, A:
Wake Forest Univ, Baptist Med Ctr, Salem, NC USA
Kaouk, J:
Cleveland Clin, Cleveland, OH 44106 USA
Kibel, AS:
Washington Univ, Sch Med, St Louis, MO USA
Maatman, T:
Michigan Urol Clin, Grand Rapids, MI USA
Menon, M:
Henry Ford Hlth Syst, Detroit, MI USA
Mottrie, A:
Onze Lieve Vrouw Hosp, Aalst, Belgium
Nepple, K:
Washington Univ, Sch Med, St Louis, MO USA
Pattaras, JG:
Emory Univ, Sch Med, Atlanta, GA USA
Peabody, JO:
Henry Ford Hlth Syst, Detroit, MI USA
Poulakis, V:
Doctors Hosp Athens, Athens, Greece
Pruthi, R:
Univ N Carolina, Wilmington, NC 28401 USA
Redorta, JP:
Fundacio Puigvert, Barcelona, Spain
Rha, KH:
Yonsei Univ Hlth Syst Severance Hosp, Seoul, South Korea
Richstone, L:
Arthur Smith Inst Urol, Long Isl City, NY USA
Schanne, F:
Urol Surg Associates Delaware, Newark, DE USA
Scherr, DS:
Samsung Med Coll, New York, NY USA
Siemer, S:
Univ Clin Saarland, Homburg, Germany
Stockle, M:
Univ Clin Saarland, Homburg, Germany
Wallen, EM:
Univ N Carolina, Wilmington, NC 28401 USA
Weizer, A:
Univ Michigan Hlth Syst, Ann Arbor, MI USA
Wiklund, P:
Karolinska Univ Hosp, Stockholm, Sweden
Wilson, T:
City Hope Natl Med Ctr, Duarte, CA USA
City Hope Natl Med Ctr, Beckman Res Inst, Duarte, CA 91010 USA
Wilding, G:
Roswell Pk Canc Inst, Buffalo, NY 14263 USA
Woods, M:
Loyola Univ, Med Ctr, Maywood, IL 60153 USA
Guru, KA:
Roswell Pk Canc Inst, Buffalo, NY 14263 USA
Green Published, Green Accepted
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