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Multicenter Study
. 2022 Feb;40(2):60.e1-60.e9.
doi: 10.1016/j.urolonc.2021.06.018. Epub 2021 Jul 22.

Intermediate-term survival of robot-assisted versus open radical cystectomy for muscle-invasive and high-risk non-muscle invasive bladder cancer in The Netherlands

Florentien J Hinsenveld  1 , Joost L Boormans  2 , Henk G van der Poel  3 , Deric K E van der Schoot  4 , André N Vis  1 , Katja K H Aben  5 , T J Arends  6 , P J Ausems  7 , D Baselmans  8 , Cpam Berger  9 , A Berrens  10 , H Bickerstaffe  11 , S D Bos  12 , M Braam  13 , K T Buddingh  7 , S Claus  14 , K Dekker  15 , T van Doeveren  16 , Smh Einerhand  3 , Lmcl Fossion  8 , E J van Gennep  17 , N van Ginkel  18 , LA Grondhuis Palacios  9 , Tjn Hermans  19 , M M Hobijn  19 , S H van Huystee  12 , M Jaspers-Valentijn  11 , O S Klaver  20 , E L Koldewijn  14 , L Korsten  21 , A Lenting  10 , K J Lentjes  17 , H B Luiting  16 , S van der Meer  15 , J A Nieuwenhuijzen  1 , M A Noordzij  18 , R I Nooter  10 , Caw Notenboom  16 , Rja Oomen  21 , Jgh van Roermund  19 , J de Rooij  8 , H Roshani  7 , B P Schrier  15 , M A van der Slot  20 , D M Somford  6 , P J Stelwagen  1 , Ama Stroux  19 , A van der West  18 , B P Wijsman  21 , Wakm Windt  13 , P van Zanten  7 , Sytse C van Beek  16 ; Dutch Cystectomy Snapshot Group
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Free article
Multicenter Study

Intermediate-term survival of robot-assisted versus open radical cystectomy for muscle-invasive and high-risk non-muscle invasive bladder cancer in The Netherlands

Florentien J Hinsenveld et al. Urol Oncol. 2022 Feb.
Free article

Abstract

Background: Radical cystectomy with pelvic lymph node dissection is the recommended treatment in non-metastatic muscle-invasive bladder cancer (MIBC). In randomised trials, robot-assisted radical cystectomy (RARC) showed non-inferior short-term oncological outcomes compared with open radical cystectomy (ORC). Data on intermediate and long-term oncological outcomes of RARC are limited.

Objective: To assess the intermediate-term overall survival (OS) and recurrence-free survival (RFS) of patients with MIBC and high-risk non-MIBC (NMIBC) who underwent ORC versus RARC in clinical practice.

Methods and materials: A nationwide retrospective study in 19 Dutch hospitals including patients with MIBC and high-risk NMIBC treated by ORC (n = 1086) or RARC (n = 386) between January 1, 2012 and December 31, 2015. Primary and secondary outcome measures were median OS and RFS, respectively. Survival outcomes were estimated using Kaplan-Meier curves. A multivariable Cox regression model was developed to adjust for possible confounders and to assess prognostic factors for survival including clinical variables, clinical and pathological disease stage, neoadjuvant therapy and surgical margin status.

Results: The median follow-up was 5.1 years (95% confidence interval ([95%CI] 5.0-5.2). The median OS after ORC was 5.0 years (95%CI 4.3-5.6) versus 5.8 years after RARC (95%CI 5.1-6.5). The median RFS was 3.8 years (95%CI 3.1-4.5) after ORC versus 5.0 years after RARC (95%CI 3.9-6.0). After multivariable adjustment, the hazard ratio for OS was 1.00 (95%CI 0.84-1.20) and for RFS 1.08 (95%CI 0.91-1.27) of ORC versus RARC. Patients who underwent ORC were older, had higher preoperative serum creatinine levels and more advanced clinical and pathological disease stage.

Conclusion: ORC and RARC resulted in similar intermediate-term OS and RFS in a cohort of almost 1500 MIBC and high-risk NMIBC.

Keywords: Bladder cancer; Cystectomy; Muscle invasive; Robot; Survival.

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Conflict of interest All authors declare no conflicts of interest.

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