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. 2023 Sep;41(9):2359-2366.
doi: 10.1007/s00345-023-04523-8. Epub 2023 Jul 31.

Long-term oncologic and functional outcomes following robot-assisted radical cystectomy and intracorporeal Padua ileal bladder: results from a single high-volume center

Gabriele Tuderti  1 , Riccardo Mastroianni  2 , Giuseppe Chiacchio  2   3 , Umberto Anceschi  2 , Alfredo Maria Bove  2 , Aldo Brassetti  2 , Mariaconsiglia Ferriero  2 , Leonardo Misuraca  2 , Rocco Simone Flammia  2   4 , Flavia Proietti  2 , Simone D'Annunzio  2 , Costantino Leonardo  2 , Salvatore Guaglianone  2 , Marianna Anselmi  2 , Ashanti Zampa  2 , Andrea Benedetto Galosi  3 , Giulia Torregiani  2 , Michele Gallucci  2 , Giuseppe Simone  2
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Long-term oncologic and functional outcomes following robot-assisted radical cystectomy and intracorporeal Padua ileal bladder: results from a single high-volume center

Gabriele Tuderti et al. World J Urol. 2023 Sep.

Abstract

Purpose: To report long-term oncologic and functional outcomes of a large consecutive single center series of Robot-assisted radical cystectomy (RARC)- intracorporeal (IC) Urinary Diversion (UD), identifying their predicting factors.

Methods: A single center Bladder cancer (BC) database was queried for "RARC" and "ICUD", including patients treated between January 2012 and September 2020. Kaplan-Meier curves were assessed disease-free (DFS), cancer-specific (CSS) and overall survival (OS) probability. Univariable (UV) and multivariable (MV) analysis were adopted to identify predictors of DFS, CSS and OS. Kaplan-Meier method evaluated day- and night-time continence recovery probabilities; UV and MV analysis were adopted to identify predictors of Day-time continence.

Results: Overall, 251 patients were included. Among them, 192 patients underwent intracorporeal ileal orthotopic neobladder (ION) (76.5%). Five-year DFS, CSS and OS rates were 66.5%, 65.4% and 61.5%; pT stage ≥ 3 and pathologic nodal involvement were identified as negative independent predictors of DFS (HR 2.39, p = 0.001, HR 4.64, p ≤ 0.001), CSS (HR 2.20, p = 0.01, HR 3.97, p < 0.001) and OS (HR 2.25, p = 0.005, HR 3.95, p < 0.001). In RARC-ION patients, Trifecta rate was 64.1%. One-year day- and night-time continence rates were 78.6% and 48.3%. Age (HR 0.98, p = 0.03), female gender (HR 0.57, p = 0.008) and complications Clavien grade ≥ 3 (HR 0.55, p = 0.03) were identified as independent predictors of day-time incontinence.

Conclusions: Long-term oncologic outcomes and their predicting factors seem aligned to the largest historical open series and multi-institutional robotic series data. According to the identified predicting factors undermining a proper achievement of day-time continence, this represents an objective support, in order to properly advice specific sub-group of patients.

Keywords: Bladder cancer; Functional outcomes; Intracorporeal urinary diversion; Robotic cystectomy; Urinary continence.

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