Differences in trends in the use of robot-assisted and open radical cystectomy and changes over time in peri-operative outcomes among selected centres in North America and Europe: an international multicentre collaboration

Stefania Zamboni^{1

2}, Francesco Soria^{3

4}, Romain Mathieu^{3

5}, Evanguelos Xylinas⁶, Mohammad Abufaraj^{3

7}, David D Andrea³, Wei Shen Tan^{8

9

10}, John D Kelly^{8

9

10}, Giuseppe Simone¹¹, Michele Gallucci¹¹, Anoop Meraney¹², Suprita Krishna¹³, Badrinath R Konety¹³, Alessandro Antonelli², Claudio Simeone², Philipp Baumeister¹, Agostino Mattei¹, Alberto Briganti¹⁴, Andrea Gallina¹⁴, Francesco Montorsi¹⁴, Michael Rink¹⁵, Atiqullah Aziz¹⁶, Pierre I Karakiewicz¹⁷, Morgan Rouprêt¹⁸, Anthony Koupparis¹⁹, Douglas S Scherr²⁰, Guillaume Ploussard²¹, Prasanna Sooriakumaran^{10

22}, Shahrokh F Shariat^{3

20

23}, Marco Moschini^{1

3}; European Association of Urology - Young Academic Urologists (EAU-YAU), Urothelial carcinoma working group³

Affiliations

¹ Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.
² Urology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili, University of Brescia, Vienna, Austria.
³ Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
⁴ Division of Urology, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy.
⁵ Department of Urology, Rennes University Hospital, Rennes, France.
⁶ Department of Urology Bichat Hospital, Paris Descartes University, Paris, France.
⁷ Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan.
⁸ Division of Surgery and Intervention Science, University College London, London, UK.
⁹ Department of Urology, University College London Hospital, London, UK.
¹⁰ Department of Uro-oncology, University College London Hospital NHS Foundation Trust, London, UK.
¹¹ Department of Urology, "ReginaElena" National Cancer Institute, Rome, Italy.
¹² Urology Division, Hartford Healthcare Medical Group, Hartford, CT, USA.
¹³ Department of Urology, University of Minnesota, Minneapolis, MN, USA.
¹⁴ Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy.
¹⁵ Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁶ Department of Urology, University Medical Center Rostock, Rostock, Germany.
¹⁷ Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada.
¹⁸ GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France.
¹⁹ Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, UK.
²⁰ Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
²¹ Department of Urology, La croix du sud, Toulouse, France.
²² Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
²³ Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.

PMID: 31055865
DOI: 10.1111/bju.14791

Differences in trends in the use of robot-assisted and open radical cystectomy and changes over time in peri-operative outcomes among selected centres in North America and Europe: an international multicentre collaboration

Stefania Zamboni et al. BJU Int. 2019 Oct.

. 2019 Oct;124(4):656-664.

doi: 10.1111/bju.14791. Epub 2019 Jun 2.

Authors

Affiliations

¹ Klinik für Urologie, Luzerner Kantonsspital, Lucerne, Switzerland.
² Urology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, ASST Spedali Civili, University of Brescia, Vienna, Austria.
³ Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria.
⁴ Division of Urology, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy.
⁵ Department of Urology, Rennes University Hospital, Rennes, France.
⁶ Department of Urology Bichat Hospital, Paris Descartes University, Paris, France.
⁷ Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan.
⁸ Division of Surgery and Intervention Science, University College London, London, UK.
⁹ Department of Urology, University College London Hospital, London, UK.
¹⁰ Department of Uro-oncology, University College London Hospital NHS Foundation Trust, London, UK.
¹¹ Department of Urology, "ReginaElena" National Cancer Institute, Rome, Italy.
¹² Urology Division, Hartford Healthcare Medical Group, Hartford, CT, USA.
¹³ Department of Urology, University of Minnesota, Minneapolis, MN, USA.
¹⁴ Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy.
¹⁵ Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁶ Department of Urology, University Medical Center Rostock, Rostock, Germany.
¹⁷ Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC, Canada.
¹⁸ GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, Sorbonne Université, Paris, France.
¹⁹ Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, UK.
²⁰ Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA.
²¹ Department of Urology, La croix du sud, Toulouse, France.
²² Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
²³ Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.

PMID: 31055865
DOI: 10.1111/bju.14791

Abstract

Objectives: To compare trends in the use of robot-assisted radical cystectomy (RARC) and changes over time in peri-operative outcomes in selected North American and European centres.

Materials and methods: We conducted a retrospective evaluation of 2401 patients treated with open radical cystectomy (ORC) or RARC for bladder cancer at 12 centres in North America and Europe between 2006 and 2018. We used the Kruskal-Wallis and chi-squared test to evaluate differences between continuous and categorical variables.

Results: Overall, 49.5% of patients underwent RARC and 51.5% ORC. RARC became the most commonly performed procedure in contemporary patients, with an increase from 29% in 2006-2008 to 54% in 2015-2018 (P < 0.001). In the North American centres the use of RARC was higher than that of ORC from 2006, and remained stable over time, whereas in the European centres its use increased exponentially from 2% to 50%. In both groups patients who underwent RARC had less advanced T stages (P < 0.001), lower American Society of Anesthesiologists scores (P < 0.05), lower blood loss (P = 0.001) and shorter length of hospital stay (P < 0.05). No differences were found in early complications. Early readmission and re-operation rates were worse for patients treated with RARC in the European centres; however, when contemporary patients only were considered, the statistical significance was lost.

Conclusion: The present study shows that the use of RARC has constantly increased since its introduction, overtaking ORC in the most contemporary series. While RARC was more frequently performed than ORC since its introduction in the North American centres and its use remained substantially stable over time, its use increased exponentially in the European centres. The different trends in use of RARC/ORC and changes over time in peri-operative outcomes between the North American and European centres can be attributed to the earlier introduction and spread of RARC in the former compared with the latter.

Keywords: #BladderCancer; #blcsm; radical cystectomy; robotic; time trend.

PubMed Disclaimer

References

1. Antoni S, Ferlay J, Soerjomataram I, Znaor A, Jemal A, Bray F. Bladder cancer incidence and mortality: a global overview and recent trends. Eur Urol 2017; 71: 96-108
1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin 2018; 68: 7-30
1. Alfred Witjes J, Lebret T, Compérat EM et al. Updated 2016 EAU guidelines on Muscle-invasive and metastatic bladder cancer. Eur Urol 2017; 71: 462-75
1. Collins JW, Patel H, Adding C et al. Enhanced recovery after robot-assisted radical cystectomy: EAU robotic urology section scientific working group consensus view. Eur Urol 2016; 70: 649-60
1. Moschini M, Simone G, Stenzl A, Gill IS, Catto J. Critical review of outcomes from radical cystectomy: can complications from radical cystectomy be reduced by surgical volume and robotic surgery? Eur Urol Focus 2016; 2: 19-29

LinkOut - more resources

Full Text Sources
- Ovid Technologies, Inc.
- Wiley

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Differences in trends in the use of robot-assisted and open radical cystectomy and changes over time in peri-operative outcomes among selected centres in North America and Europe: an international multicentre collaboration

Affiliations

Differences in trends in the use of robot-assisted and open radical cystectomy and changes over time in peri-operative outcomes among selected centres in North America and Europe: an international multicentre collaboration

Authors

Affiliations

Abstract

References

LinkOut - more resources

Full Text Sources