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Early oncologic outcomes of robotic vs. open radical cystectomy for urothelial cancer
Journal article   Open access   Peer reviewed

Early oncologic outcomes of robotic vs. open radical cystectomy for urothelial cancer

Kenneth G Nepple, Seth A Strope, Robert L Grubb III and Adam S Kibel
Urologic oncology, Vol.31(6), pp.894-898
08/2013
DOI: 10.1016/j.urolonc.2011.06.009
PMCID: PMC4090045
PMID: 21803615
url
https://doi.org/10.1016/j.urolonc.2011.06.009View
Published (Version of record) Open Access

Abstract

Oncologic outcomes of robotic cystectomy have focused on pathology and not on survival endpoints. We compared pathology, recurrence, and survival in a single surgeon series of open and robotic cystectomy since the introduction of robotic cystectomy. We identified all patients treated by a single surgeon with radical cystectomy for urothelial cancer from June 2007 to June 2010. Clinical, demographic, and pathologic data was abstracted from chart review. Mortality was obtained from institutional cancer registry and chart review. Patients were excluded from analysis for a relative contraindication to robotic surgery. The remaining cohort of patients undergoing robotic (n = 36) vs. open (n = 29) cystectomy with median follow-up 12.2 months were evaluated. The robotic cohort was more likely to be older and male (P < 0.05). Obesity, comorbidity, preoperative pathology, and receipt of neoadjuvant chemotherapy were not different between groups. Three patients had conversion from robotic to open cystectomy because of difficult dissection. Mean surgical time was longer in robotic cystectomy (410 vs. 345 minutes, P < 0.01). Cystectomy pathology was not different for robotic vs. open surgery for stage, margin status, or mean node count (robotic: 17.0, open: 15.5). On survival analysis robotic and open cystectomy outcomes were similar with respect to recurrence-free, disease-specific, and overall survival (all log-rank P values > 0.05). The Kaplan-Meier estimate for 2-year outcome for recurrence-free, disease-specific, and overall survival was 67% (95% CI: 41-83), 75% (95% CI: 53-88), 68% (95% CI: 47-82) for robotic cystectomy and 58% (95% CI: 29-79), 63% (95% CI: 34-82), 63% (95% CI: 34-82) for open cystectomy. Short-term oncologic outcomes were similar for open and robotic cystectomy. Increased sample size and further follow-up are necessary before claiming equivalent long-term survival.
 Robotics Registries Humans Middle Aged Male Surgery, Computer-Assisted - methods Treatment Outcome Urinary Bladder Neoplasms - surgery Cystectomy - instrumentation Sample Size Comparative Effectiveness Research Female Aged Carcinoma, Transitional Cell - surgery Urothelium - surgery Cystectomy - methods Cohort Studies

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