Robot-Assisted Radical Cystectomy: A Single-Center Experience and a Narrative Review of Recent Evidence
Abstract
:1. Introduction
2. Materials and Methods
2.1. Included Variables
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- Demographics and pre-operative variables: Age, BMI, previous surgery, co-morbidities, ECOG, ASA score; cT, cN status; prior NAC.
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- Intra-operative: Complication rate; urinary diversion rate stratified into ICUD (neobladder and ileal conduit), and uretero-cutaneostomy.
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- Post-operative and pathological data: Histological type and differentiation; pT/ypT, pN/ypN; histological grade; surgical margin status; incidental finding of prostate cancer; length of stay (LOS); complication rate; Clavien–Dindo classification of complications; thromboembolic event, wound infection rate; 30-day overall re-admission rate.
2.2. Endpoint
2.3. Surgical Technique
3. Results
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Age, Mean (SD), Range | 66 (10), 46–80 |
Sex | |
Male | 33/40 (82.5) |
Female | 7/40 (17.5) |
Eastern Cooperative Oncology Group Performance Status | |
0: Fully active | 32/40 (80%) |
1: Restricted in strenuous activity | 5/40 (12.5) |
2: Self-caring but unable to work | 1/40 (2.5) |
3: limited self-care | 1/40 (2.5) |
BMI | 26 (3.7), 17–37 |
Smoking (current or previous) (%) | 25/40 (62.5) |
Preoperative hemoglobin, mean (SD), g/dL | 12.8 (1.8), 9–16 |
Preoperative creatinine, mean (SD), ml/dL | 1 (0.2), 0.6–1.7 |
Neoadjuvant chemotherapy | 9/40 (22.5%) |
Cystectomy histology pathologic tumor stage | |
pT0 or ypT0 | 6 (15) |
pTa | 2 (5) |
pTis | 6 (15) |
pT1 | 3 (7.5%) |
pT2 | 11 (27.5%) |
pT3 | 7 (17.5) |
pT4 | 5 (12.5) |
Cystectomy Histology Grade | |
Low (LG) | 5/34 (15%) |
High (HG) | 29/34 (85%) |
Positive surgical margins | 0 |
Histological stage N | |
N0 (%) | 29 (72.5) |
N1 (%) | 8 (20) |
N3 (%) | 1 (2.5) |
N3 (%) | 1 (2.5) |
Concomitant Prostate cancer (%) | 6/33 (18.1) |
Type of Diversions | |
Intracorporeal neobladder | 20 (50) |
Ileal conduit | 9 (22.5) |
Ureterocutaneostomy | 11 (27.5) |
Intra-operative complications | 1/40 (2.5) |
Post-operative complications—Clavien-Dindo Classification | |
I (%) | 8/40 (20) |
II (%) | 11/40 (27.5) |
IIIa (%) | 3/40 (7.5) |
IIIb (%) | 0/40 * |
IV (%) | 0 |
Thromboembolic event | 0 |
Wound infection | 1/40 (2.5) |
30-day re-admission rate | |
No | 30 (75) |
Yes | 10 (25) |
Author | Years | Comparison | N° of Patients | Primary End Point | Secondary End Point | ICUD/ECUD | Main Findings |
---|---|---|---|---|---|---|---|
Parekh et al. (RAZOR) [13] | 2018 | ORC vs. RARC | 302 | 2-year progression-free survival | Adverse events Urinary tract infection Postoperative ileus | ECUD | 2-year PFS 72.3% (95% CI 64.3 to 78.8) with RARC 2-year PFS 71.6% (95% CI 63.6 to 78·2) with ORC (difference of 0.7%, 95% CI −9.6% to 10.9%; p non-inferiority = 0.001) Adverse events: 101 (67%) of 150 RARC; 105 (69%) of 152 ORC |
Becerra et al. (RAZOR update) [14] | European urology 2020 | ORC vs. RARC | Quality-of-care indicators (QOCIs) | ECUD | No difference | ||
Nix et al. [15] | European Urology 2009 | ORC vs. RARC | 41 | Primary end point: LN yield. | Perioperative outcomes: EBL, OR time, Time to flatus, Time to BM, Length of stay In-house analgesia, Clavien complication | ECUD | LN—non inferiority Results favor RARC in several perioperative parameters including EBL and narcotic requirements; longer OT |
Bochner et al. [16] | European Urology 2014 | Open vs. RARC | 118 | 90-d grade 2–5 complications | comparison of high-grade complications, EBL, OT, pathologic outcomes, PSM, 3- and 6-month patient-reported quality-of-life (QOL), and total operative room and inpatient costs. | ECUD | At 90 d, grade 2–5 complications were 62% with RARC and 66% ORC (95% CI for difference, 21% to 13%; p = 0.7). The RARC group had lower EBL (p = 0.027) but significantly longer OT than the ORC. Margins and lymph node yields were similar; LOS was 8 d in both arms Three- and six-month QOL outcomes were similar between arms. Cost analysis demonstrated an advantage for ORC compared with RARC. |
Khan et al. (CORAL) [17] | 2015 | Open vs. RARC vs. LRC | 60 | 30- and 90-d complication rates. | perioperative clinical, pathologic, and oncologic outcomes, and quality of life (QoL) | ECUD | 30-d complication rates (ORC: 70%; RARC: 55%; LRC: 26%; p = 0.024). The 90-day rate did not differ (ORC: 70%; RARC: 55%; LRC 32%; p = 0.068). Mean OT was significantly longer in RARC compared to ORC or LRC. There were no significant differences in QoL |
Khan et al. (CORAL) [18] | 2020 | Open/LPS/RA | 60 | 5-year oncological outcomes: Recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). | ECUD | The 5-year: RFS was 60%, 58%, and 71%; CSS was 64%, 68%, and 69%; OS was 55%, 65%, and 61% for ORC, RARC, and LRC No significant differences | |
Catto et al. (iROC) [10] | 2022 | ORC vs. RARC | 317 | recovery and morbidity— number of days alive and out of the hospital within 90 days of surgery. | 20 secondary outcomes, including complications, quality of life, disability, activity levels, and survival | ICUD | 82 vs. 80 days alive and out of the hospital within 90 days of surgery; the clinical importance of these findings remains uncertain; advantage of RARC in terms of wound infection and thromboembolic event |
Mastroianni et al. [11] | 2022 | ORC vs. RARC | 116 | To evaluate the superiority of RARC with ICUD in terms of 50% transfusion rate reduction | Early outcomes | ICUD | 22% and 44% peri-operative transfusion rates with RARC and ORC, confirming a benefit for RARC with ICUD; peri-operative complications, LOS and 6-mo QoL similar between groups |
Mastroianni et al. [19] | 2022 | ORC vs. RARC | 51 | 1-year health-related quality of life (HRQoL) questionnaires Global health status/QoL Physical functioning Emotional functioning Social functioning Fatigue Pain Insomnia Constipation sexual functioning, urinary symptoms, abdominal bloating and flatulence, diarrhea, appetite loss, dyspnea, nausea and vomiting, | Perioperative and early postoperative outcomes, EBL, ERAS protocol, hospital stay, perioperative complication, readmission 30–90 days, complications at 30 days and 90 days. | ICUD | Both groups significant worsening of body image and physical and sexual functions (all p 0.012). Patients receiving ORC were more likely to report significant 1-year impairment of role functioning, symptoms scales and bowel symptoms (all p 0.048). Patients receiving RARC reported significant impairment of urinary symptoms and problems (p = 0.018) Robotic surgery seems to provide benefits for most quality-of-life items on patient |
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Rocco, B.; Garelli, G.; Assumma, S.; Turri, F.; Sangalli, M.; Calcagnile, T.; Gaia, G.; Terzoni, S.; Oliviero, G.; Stroppa, D.; et al. Robot-Assisted Radical Cystectomy: A Single-Center Experience and a Narrative Review of Recent Evidence. Diagnostics 2023, 13, 714. https://doi.org/10.3390/diagnostics13040714
Rocco B, Garelli G, Assumma S, Turri F, Sangalli M, Calcagnile T, Gaia G, Terzoni S, Oliviero G, Stroppa D, et al. Robot-Assisted Radical Cystectomy: A Single-Center Experience and a Narrative Review of Recent Evidence. Diagnostics. 2023; 13(4):714. https://doi.org/10.3390/diagnostics13040714
Chicago/Turabian StyleRocco, Bernardo, Giulia Garelli, Simone Assumma, Filippo Turri, Mattia Sangalli, Tommaso Calcagnile, Giorgia Gaia, Stefano Terzoni, Guglielmo Oliviero, Daniele Stroppa, and et al. 2023. "Robot-Assisted Radical Cystectomy: A Single-Center Experience and a Narrative Review of Recent Evidence" Diagnostics 13, no. 4: 714. https://doi.org/10.3390/diagnostics13040714