Robot-assisted Versus Open Radical Cystectomy in Patients Receiving Perioperative Chemotherapy for Muscle-invasive Bladder Cancer: The Oncologist’s Perspective from a Multicentre Study - Université de Bourgogne Accéder directement au contenu
Article Dans Une Revue European Urology Focus Année : 2018

Robot-assisted Versus Open Radical Cystectomy in Patients Receiving Perioperative Chemotherapy for Muscle-invasive Bladder Cancer: The Oncologist’s Perspective from a Multicentre Study

1 IRCCS Istituto Nazionale dei Tumori [Milano]
2 McMaster University [Hamilton, Ontario]
3 Fox Chase Cancer Center
4 City of Hope Comprehensive Cancer Center [Duarte]
5 UAB Comprehensive Cancer Center UAB Comprehensive Cancer Center [Birmingham, AL, USA]
6 Dana-Farber Cancer Institute [Boston]
7 University of Southampton
8 University of Michigan [Ann Arbor]
9 Guy's and St Thomas' Hospital [London]
10 Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS
11 Stanford School of Medicine [Stanford]
12 University of Utah School of Medicine [Salt Lake City]
13 NKUA - National and Kapodistrian University of Athens
14 Rabin Medical Center - Beilinson and Hasharon Hospitals [Petach-Tikva, Israel]
15 MUSC - Medical University of South Carolina [Charleston]
16 UNICANCER/CRLCC-CGFL - Centre Régional de Lutte contre le cancer Georges-François Leclerc [Dijon]
17 San Camillo Forlanini Hospital [Rome]
18 University of Washington [Seattle]
19 Karmanos Cancer Institute
20 Heinrich Heine Universität Düsseldorf = Heinrich Heine University [Düsseldorf]
21 University of Liverpool
22 VHIO - Vall d'Hebron Institute of Oncology [Barcelone]
23 UNC - University of North Carolina [Chapel Hill]
24 Hôpital Foch [Suresnes]
25 CHUV - Centre Hospitalier Universitaire Vaudois = Lausanne University Hospital [Lausanne]
26 University of Toronto, Princess Margaret Hospital
27 Barts & The London School of Medicine
28 Memorial Sloane Kettering Cancer Center [New York]
29 Tisch Cancer Institute
Daniel Bowles
  • Fonction : Auteur
Christine Théodore
  • Fonction : Auteur
  • PersonId : 907559

Résumé

Background Little is known about the outcomes of robot-assisted radical cystectomy (RARC) compared to open radical cystectomy (ORC) combined with perioperative chemotherapy for muscle-invasive urothelial bladder cancer (UBC). Objective To evaluate surgical and oncological outcomes for RARC and ORC in multimodal treatment. Design, setting, and participants Data from 28 centres were collected for cystectomies performed between January 2000 and July 2013. Intervention RARC or ORC combined with perioperative chemotherapy for UBC. Outcome measures and statistical analysis Fisher’s exact tests, χ2 tests, and Wilcoxon rank-sum tests were used to compare the RARC and ORC groups. Logistic and Cox regression analyses were performed to evaluate potential prognostic factors. Results and limitations A total of 688 patients (n = 603 ORC and n = 85 RARC) were analysed; 60.6% received neoadjuvant chemotherapy, and 45.1% adjuvant chemotherapy. No significant differences in baseline characteristics were found between the groups. The median time from surgery to adjuvant chemotherapy was 1.9 mo for both RARC and ORC groups. The median number of lymph nodes removed was 21 (interquartile range [IQR] 14–35) for RARC and 13 (IQR 8–21) for ORC (p < 0.001); the results were confirmed in subgroup analyses. Multivariable analyses revealed no difference in the rate of positive surgical margins (p = 0.54 and p = 0.78), rate of neobladder diversion (p = 0.33 and p = 0.51), relapse-free survival (p = 0.31 and p = 0.23), and overall survival (p = 0.63 and p = 0.69). The retrospective nature of the data is the major limitation. Conclusions In this study, no differences in efficacy outcomes or ability to deliver adjuvant chemotherapy were observed between RARC and ORC. The increasing use of RARC is justifiable from an oncological viewpoint. Patient summary In a retrospective study of patients who received perioperative chemotherapy for urothelial bladder cancer, we found no difference in key outcomes between robot-assisted radical cystectomy (RARC) and open radical cystectomy. Performing RARC seems to be justifiable in the multidisciplinary setting.

Dates et versions

hal-01697161 , version 1 (31-01-2018)

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Andrea Necchi, Gregory Pond, Marc Smaldone, Sumanta Pal, Kevin Chan, et al.. Robot-assisted Versus Open Radical Cystectomy in Patients Receiving Perioperative Chemotherapy for Muscle-invasive Bladder Cancer: The Oncologist’s Perspective from a Multicentre Study. European Urology Focus, 2018, 4 (6), pp.937-945. ⟨10.1016/j.euf.2017.03.011⟩. ⟨hal-01697161⟩
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