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Efficacy of robot‐assisted radical cystectomy ( RARC ) in advanced bladder cancer: results from the I nternational R adical C ystectomy C onsortium ( IRCC )
Author(s) -
AlDaghmin Ali,
Kauffman Eric C.,
Shi Yi,
Badani Ketan,
Balbay M. Derya,
Canda Erdem,
Dasgupta Prokar,
Ghavamian Reza,
Grubb Robert,
Hemal Ashok,
Kaouk Jihad,
Kibel Adam S.,
Maatman Thomas,
Me Mani,
Mottrie Alex,
Nepple Kenneth,
Pattaras John G.,
Peabody James O.,
Poulakis Vassilis,
Pruthi Raj,
Palou Redorta Juan,
Rha KoonHo,
Richstone Lee,
Schanne Francis,
Scherr Douglas S.,
Siemer Stefan,
Stöckle Michael,
Wallen Eric M.,
Weizer Alon,
Wiklund Peter,
Wilson Timothy,
Wilding Gregory,
Woods Michael,
Guru Khurshid A.
Publication year - 2014
Publication title -
bju international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.773
H-Index - 148
eISSN - 1464-410X
pISSN - 1464-4096
DOI - 10.1111/bju.12569
Subject(s) - medicine , cystectomy , bladder cancer , urology , pathological , stage (stratigraphy) , body mass index , chemotherapy , surgery , gastroenterology , cancer , paleontology , biology
Objective To characterise the surgical feasibility and outcomes of robot‐assisted radical cystectomy ( RARC ) for pathological T 4 bladder cancer. Patients and Methods Retrospective evaluation of a prospectively maintained I nternational R adical C ystectomy C onsortium 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 T 4 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 ), A merican S ociety of A nesthesiology 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.