Journal Article

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

Flammia, Rocco Simone, Guaglianone, Salvatore, Chiacchio, Giuseppe, Mastroianni, Riccardo, Tuderti, Gabriele, Zampa, Ashanti, Leonardo, Costantino, Bove, Alfredo Maria, Anceschi, Umberto, Brassetti, Aldo, Anselmi, Marianna, Simone, Giuseppe, Misuraca, Leonardo, D’Annunzio, Simone, Galosi, Andrea Benedetto, Proietti, Flavia, Gallucci, Michele, Torregiani, Giulia, Ferriero, Mariaconsiglia

2023

Overview

PurposeTo 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.MethodsA 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.ResultsOverall, 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.ConclusionsLong-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.

• Publisher: Springer Nature B.V
• Subject: Bladder cancer / Nighttime / Robotic surgery / Urological surgery