Search Results (45)

Background: Local recurrences following radical prostatectomy (RP) are typically attributed to incomplete surgical resection or positive surgical margins (PSMs). Yet approximately 70% of men with PSMs never experience BCR. Prostate-specific membrane antigen PET scans (PSMA PET) are useful in detecting the incidence and location of recurrence sites. This study explores the relationship between margin status and local and metastatic recurrences using PSMA PET scans. Methods: A retrospective study was conducted with prospectively collected data following RARP with BCR in 159 men undergoing PSMA PET (2017–2023). The primary outcome compared risk and location of recurrences between NSM vs. PSM. A total of 13 cases (8%) had “equivocal” PET scan findings which were assessed first as all positive and then all negative. Results: Of 159 men with BCR undergoing PSMA PET scans, 101 (63.5%) had NSMs and 58 (36.5%) had PSMs. Assuming all 13 “equivocal” scans were positive, the risk of a positive PSMA PET is NSMs vs. PSMs (73% vs. 69% p = 0.56). Local recurrence rates did not differ significantly (NSMs 39.2% vs. PSMs 45% p = 0.55), nor did lymph nodes (NSMs 61% vs. PSMs 58% p = 0.73) or bone lesions (NSMs 16.2% vs. PSMs 22.5% p = 0.41). Multivariate regression analysis showed that margin status was not a predictor of local recurrence (OR 1.40; 95% CI [0.65, 1.54]; p = 0.382). Conclusions: Local recurrence occurs at about the same rate independent of margin positivity status, suggesting that local recurrences appear to be more closely related to metastatic dissemination, not incomplete resection. These findings question the oncologic rationale for wider resections at the expense of functional outcomes. Full article

Background/Objectives: The purpose of this study was to investigate the association between HER-2 expression and clinicopathological characteristics, biochemical recurrence (BCR) rate, and BCR-free survival in localized prostate cancer (PCa) patients after radical prostatectomy (RP). Methods: Between January 2018 and December 2019, 44 patients with pathologically confirmed localized PCa who underwent RP were included in this study. According to the expressed level of HER-2 protein, patients were divided into four cohorts: cohort-1 (HER-2 0), cohort-2 (HER-2 1+ or 2+), cohort-3 (HER-2 0 or 1+), and cohort-4 (HER-2 2+); the clinicopathological and clinical outcomes were analyzed and compared between cohort-1 and cohort-2, and cohort-3 and cohort-4, respectively. Univariable and multivariable COX regression models and Kaplan–Meier curves were used to determine the association between HER-2 expression and clinicopathological outcomes, including Gleason score (GS), pathological T (pT) stage, positive surgical margins (PSM), and BCR-free survival, respectively. Results: The median follow-up time was 43 months (IQR 35–49). Among the 44 patients, 20 (45.5%) exhibited HER-2 immuno-reactivity, including 14 (31.8%) with HER-2 1+, 6 (13.64%) with HER-2 2+, and 0 (0%) with HER-2 3+ staining. The proportion of patients with PSM was significantly lower in the HER-2 0 group than in those with HER-2 1+ or 2+ (25.0% vs. 65.0%, p = 0.008). Multivariable logistics regression models revealed that HER-2 1+ or 2+ was an independent risk factor that was strongly associated with a higher proportion of PSM (OR, 2.69; 95% CI, 0.62–11.71, p = 0.042). A total of 18 (40.9%) patients experienced BCR after surgery, including 6 (25%) in cohort-1 and 12 (60.0%) in cohort-2 (p = 0.019), as well as 13 (34.2%) in cohort-3 and 5 (83.3%) in cohort-4 (p = 0.023). Kaplan–Meier analysis showed that patients in cohort-1 (HER-2 0) had significantly longer BCR-free survival than those in cohort-2 (HER-2 1+ or 2+) (p < 0.001), and those in cohort-3 had longer BCR-free survival than those in cohort-4 (p < 0.001). Furthermore, patients with PSM showed significantly shorter BCR-free survival compared to those with patients with negative surgical margins (NSM) (p = 0.005). Multivariable Cox regression analysis revealed that HER-2 1+, 2+ (HR, 17.00; 95% CI, 1.38–210.22, p < 0.001), HER-2 2+ (HR, 2.85; 95% CI, 1.23–3.25, p = 0.004), and PSM (HR, 6.12; 95% CI, 3.08–11.72, p = 0.007) were all significant independent predictors of BCR following surgery. Conclusions: HER-2 expression is a common phenomenon in PCa; nearly half of the proportion of localized PCa had HER-2 1+ or 2+, but the cases that expressed HER-2 3+ were rare. Cases with HER-2 1+ or 2+ were more likely to develop BCR compared with HER-2 0. The HER-2 1+ or 2+ expression was closely associated with a higher incidence of PSM and was an independent predictor of shorter BCR-free survival in patients with localized prostate cancer after radical prostatectomy. Full article

Background: This study aimed to develop and evaluate machine learning (ML) models to predict biochemical recurrence (BCR) after robot-assisted radical prostatectomy (RARP). Methods: We retrospectively analyzed clinical data from 1125 patients who underwent RARP between July 2013 and December 2023. The dataset was divided into a training set (70%) and a testing set (30%) using a stratified sampling strategy. Five ML models were developed using the training set. Model performance was evaluated on the testing set using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, and F1 scores. Additionally, model interpretability was assessed using SHapley Additive exPlanations (SHAP) values to determine the contribution of individual features. Results: Among the five ML models, the LightGBM model achieved the best prediction ability with an AUC of 0.881 (95%CI: 0.840–0.922) in the testing set. For model interpretability, SHAP values explained the contribution of individual features to the model, revealing that pathological T stage (pT), positive surgical margin (PSM), prostate-specific antigen (PSA) nadir, initial PSA, systematic prostate biopsy positive rate, seminal vesicle invasion (SVI), pathological International Society of Urological Pathology Grade Group (pGG), and perineural invasion (PI) were the key contributors to the predictive performance. Conclusions: We developed and validated ML models to predict BCR following RARP and identified that the LightGBM model with 8 variables achieved promising performance and demonstrated a high level of clinical applicability. Full article

Objective: To evaluate the perioperative outcomes, functional impact, and oncologic efficacy of off-clamp robotic-assisted partial nephrectomy (RAPN) in patients with renal masses across multiple high-volume centers. Materials and Methods: We conducted a retrospective multicenter study including 563 patients (group 1) who underwent clampless RAPN between January 2018 and December 2024. Patients with solitary kidneys, tumors >7 cm, or prior renal surgery were excluded. The standardized surgical technique involved tumor resection without clamping of the renal artery, followed by the use of hemostatic agents and standard/selective suturing of the resection bed on demand. Patients in group 1 were compared to 244 consecutive patients treated in the same centres and treated with RAPN with an on-clamp procedure (group 2). Primary outcomes included operative time, blood loss, and complications, while secondary outcomes assessed renal function preservation and oncologic control at an at least 12-month follow-up. Results: The median operative time was 118 min (IQR: 100–140 min), and median estimated blood loss was 150 mL (range: 50–400 mL). The overall complication rate was 9.2%, with most classified as Clavien–Dindo Grade I–II. No intraoperative conversions to open surgery were recorded. Renal function was well preserved, with a median estimated glomerular filtration rate (eGFR) decline of 4.1% at three months (p > 0.05), and no cases of acute kidney injury. Oncologic outcomes were favorable, with a positive surgical margin rate (PSM) of 2.4% and two cases of tumor recurrences (0.36%) documented at a 12-month follow-up. Conclusions: The off-clamp RAPN is a safe and effective nephron-sparing approach, offering significant renal function preservation while maintaining oncologic efficacy. This technique minimizes ischemia–reperfusion injury and post-surgical fibrosis, providing a viable alternative to on-clamp RAPN. Further prospective trials are warranted to confirm long-term benefits and refine patient selection criteria. Full article

We investigated the clinical significance of positive surgical margins (PSMs) in index tumors following radical prostatectomy (RP), with particular attention to the tumor’s zonal origin. Among 1148 patients with localized prostate cancer who underwent RPs, 973 were included after excluding those who received perioperative therapy or had incomplete data. Index tumors were categorized by zonal origin: transition zone, peripheral zone, or central zone (CZ). Overall, PSMs were observed in 26.4% of index tumors. Although CZ index tumors were relatively uncommon (6.5%), they exhibited the highest PSM rate (42.9%) and showed the most aggressive pathological features. The 5-year biochemical recurrence (BCR)-free survival rate was significantly lower in patients with PSMs in index tumors than in those with negative surgical margins (45.6% vs. 86.8%, p < 0.0001). Notably, patients with PSMs in CZ index tumors had the worst outcomes, with a 5-year BCR-free survival rate of 22.0%. Multivariate analysis identified PSMs in index tumors as an independent predictor of BCR (HR: 3.4; 95% CI: 2.5–4.5), with a similar trend observed in early recurrence. These findings highlight the prognostic significance of PSMs in index tumors during RP, especially in CZ tumors, and emphasize the importance of securing local control in these cases. Full article

Objectives: In this study, the effect of positive surgical margin (PSM) length on predicting postoperative biochemical recurrence (BCR) after radical prostatectomy was evaluated, and based on the findings, an additional R subclassification to the TNM-R system was proposed. Methods: We retrospectively analyzed patients who underwent robot-assisted radical prostatectomy between 30 July 2008 and 31 December 2019. Only patients with PSM were included. Those with negative margins, those receiving neoadjuvant/adjuvant hormone therapy, or those with prior pelvic radiotherapy were excluded. A total of 353 pathology specimens were re-evaluated by a uropathologist, and the PSM length was quantitatively measured. BCR was defined as a PSA level of ≥0.2 ng/mL in two consecutive measurements. Results: The median follow-up time of the patients was 49.5 ± 33.4 months. BCR occurred in 27.1% (n = 96) of patients. A PSM cut-off length of 3.5 mm was identified for predicting BCR (p < 0.001). Among patients with PSM < 3.5 mm, 9.8% experienced BCR, while 54.3% of those with PSM ≥ 3.5 mm did. A PSM length ≥ 3.5 mm was associated with a higher risk of recurrence (OR: 1.249, 95% CI: 1.160–1.345, p < 0.001). In multivariate logistic regression analysis, PSM length remained an independent prognostic factor for BCR (p < 0.001). Conclusions: Quantitative measurement of PSM length serves as an independent predictor of BCR following radical prostatectomy. We propose subclassifying R1 margins into R1a (<3.5 mm) and R1b (≥3.5 mm), which may enhance prognostic accuracy in pathological reporting. Full article

Objectives: To evaluate the prognostic impact of positive surgical margins (PSMs) after partial or radical nephrectomy for clear cell renal cell carcinoma (ccRCC) across AJCC stages and assess its relevance to adjuvant therapy eligibility, given that landmark trials excluded patients with PSMs. Methods: We conducted a retrospective study using the National Cancer Database, including 171,151 ccRCC patients treated with partial or radical nephrectomy (2004–2020). Patients receiving systemic therapy or with missing key data were excluded. OS was analyzed using Kaplan–Meier curves, log-rank tests, and multivariable Cox regression. Subgroup analyses compared T2 G2/G3 PSM vs. T2 G4 negative surgical margin (NSM) (N0/Nx M0) and assessed PSM impact within KEYNOTE-564 risk groups. Results: PSMs were present in 5.9% of patients and independently predicted worse OS (HR 1.43; p < 0.001). No OS difference was observed in AJCC stage I (p = 0.54), while stages II (p = 0.001), III, and IV (p < 0.001) showed poorer survival with PSMs. OS in patients with T2 G2/G3 tumors and PSMs was comparable to those with T2 G4 and NSMs (p = 0.69). Within the KEYNOTE-564 risk population, PSMs were associated with a 62% increased risk of death (HR 1.62; p < 0.001). Conclusions: PSMs are independently associated with worse OS in ccRCC. Their prognostic impact varies across AJCC stages, supporting the use of margin status to refine risk models, guide surveillance, and consider PSM patients for adjuvant trials. Full article

Emerging imaging-guided technologies, such as prostate-specific membrane antigen radioguided surgery (PSMA-RGS) and augmented reality (AR), could enhance the precision and efficacy of robot-assisted prostate cancer (PCa) surgical approaches, maximizing the surgeons’ ability to remove all cancer sites and thus patients’ outcomes. Sentinel node biopsy (SNB) represents an imaging-guided technique that could enhance nodal staging accuracy by leveraging lymphatic mapping with tracers. PSMA-RGS uses radiolabeled tracers with the aim to improve intraoperative lymph node metastases (LNMs) detection. Several studies demonstrated its feasibility and safety, with promising accuracy in nodal staging during robot-assisted radical prostatectomy (RARP) and in recurrence setting during salvage lymph node dissection (sLND) in patients who experience biochemical recurrence (BCR) after primary treatment and have positive PSMA positron emission tomography (PET). Near-infrared PSMA tracers, such as OTL78 and IS-002, have shown potential in intraoperative fluorescence-guided surgery, improving positive surgical margins (PSMs) and LNMs identification. Finally, augmented reality (AR), which integrates preoperative imaging (e.g., multiparametric magnetic resonance imaging [mpMRI] of the prostate and computed tomography [CT]) onto the surgical field, can provide a real-time visualization of anatomical structures through the creation of three-dimensional (3D) models. These technologies may assist surgeons during intraoperative procedures, thus optimizing the balance between oncological control and functional outcomes. However, challenges remain in standardizing these tools and assessing their impact on long-term PCa control. Overall, these advancements represent a paradigm shift toward personalized and precise surgical approaches, emphasizing the integration of innovative strategies to improve outcomes of PCa patients. Full article

Background: Despite numerous studies assessing LCs in urological surgical oncology, high-quality evidence and a fully structured curriculum are missing. We aimed to systematically search and review the available literature on the LCs of robot-assisted surgery in urological cancers. Methods: Medline was systematically searched up to December 2024 to retrieve studies following the Preferred Reporting Items reporting on LC in robot-assisted radical prostatectomy (RARP), robot-assisted radical cystectomy (RARC), robot-assisted radical and partial nephrectomy (RARN, RAPN), and robot-assisted radical nephroureterectomy (RANU). The results of the last five years were then compared to those of the previous years. Results: In total, 82 studies were identified, 47 of which were for prostatectomy, 9 of which were for the last 5 years. Eighteen studies referred to partial-nephrectomy, seven over the previous 5 years. Finally, 16 studies referred to radical cystectomy, 7 over the previous five years. For radical prostatectomy, LC was based on operative time (OT), estimated blood loss (EBL), length of hospital stays, complication rate, positive surgical margin (PSM), biochemical recurrence (BCR), continence, and potency with ranges of 100–400, 90–290, 200, 15–250, 50–300, 30–250, 200–500 and 200–300 cases, respectively. For partial nephrectomy, the LC was based on OT, EBL, length of hospital stay, complication rate, warm ischemia time (WIT), and trifecta, with unclear ranges for the first three categories and 20–50, 26–140, and 50–77 cases, respectively, for the rest. Finally, for radical cystectomy, the LC was based on OT, EBL, length of hospital stay, complication rate, PSM, and lymph node yield, with ranges 20–75, 88, 40–198, 16–100, no difference, and 30–50 cases, respectively. We could not identify any study assessing the LCs in RARN and RANU. Conclusions: Robot-assisted surgery does not have a standard definition of LC regardless of the type of operation, which causes heterogeneity between the studies. Nevertheless, LCs appear to be steep and continuous. Training curriculums are essential to optimize outcomes and prepare new surgeons. Full article

Objectives: We attempt to assess whether prostate-specific antigen decline rate in the first month (PSADR1M = postoperative PSA in the first month/initial PSA) acts as a predictor for biochemical recurrence (BCR) and to evaluate other preoperative and postoperative variables that may predict BCR following robot-assisted laparoscopic prostatectomy (RARP). Method: Based on the D’Amico risk classification system, 777 patients who underwent RARP for localized prostate cancer were classified into a low/intermediate-risk group (n = 435) and a high-risk group (n = 342). The predictors of BCR were identified by univariate and multivariate logistic regression analyses. The area under the curve (AUC) and optimal cutoff values of PSADR1M were determined by receiver operating characteristic (ROC) analysis. Kaplan–Meier curves for biochemical recurrence-free survival (BRFS) rates were stratified by optimal cutoff values of PSADR1M. Results: Effective predictors of BCR in the entire cohort included pT3 (p < 0.001), pathological Grade Group (pGG3, pGG4+5) compared to pGG1+2 (p < 0.001, p = 0.017), positive surgical margins (PSM) (p < 0.001), seminal vesicle invasion (SVI) (p = 0.006), and PSADR1M ≥ 0.62% (p < 0.001). ROC analysis showed that PSADR1M as a predictor for BCR had an AUC of 0.762 for the whole cohort, and 0.821 for the high-risk group, respectively. The optimal cutoff values of PSADR1M were 0.62% in the whole cohort, and 0.68% in high-risk group. Conclusions: As an effective predictor of BCR, PSADR1M can assess the tumor status of prostate cancer patients intuitively and effectively after RARP, especially in the high-risk group. Full article

Background and Objectives: We conducted a systematic review and network meta-analysis to evaluate and compare the perioperative, functional, and oncological outcomes of robot-assisted radical prostatectomy (RARP) and laparoscopic radical prostatectomy (LRP) with open radical prostatectomy (ORP) in patients with prostate cancer. Materials and Methods: A comprehensive literature search was performed in Pubmed, EMBASE, and the Cochrane library for papers published before May 2021. Only studies of patients with prostate cancer that assessed perioperative, functional, and oncological outcomes and reported outcome values were included. We used a Bayesian hierarchical random-effects model to synthesize data from multiple studies, enabling both direct and indirect comparisons of the three surgical approaches (RARP, LRP, ORP) to provide robust estimates of their relative efficacy. This systematic review was registered in PROSPERO (CRD42021282555). Results: A total of 80 studies were finally included in the present study. Biochemical recurrence (BCR) rates were lower for RARP than for ORP (RR 0.713, 95% CrI 0.587–0.869) and LRP (RR 0.672, 95% CrI 0.505–0.895). Compared with ORP, RARP had a significantly lower positive surgical margin (RR 0.893, 95% CrI 0.807–0.985). When compared to ORP, RARP and LRP showed no significant difference in continence (RR 1.057, 95% CrI 0.997–1.124; RR 0.921, 95% CrI 0.845–1.007). When compared to ORP, RARP was significantly more effective on potency (RR 1.201, 95% CrI 1.047–1.402). The potency rate was significantly higher for RARP than for ORP (RR 1.201, 95% CrI 1.047–1.402) and LRP (RR 1.438, 95% CrI 1.191–1.762). There was no difference in the estimated blood loss or the total and major complication rates between RARP, ORP, and LRP. The operation time was longest for LRP. There was no difference in the operation time between RARP and ORP. Conclusions: RARP may be better or comparable to ORP and LRP in terms of oncologic outcomes (PSM and BCR), functional outcomes (potency and incontinence), and perioperative outcomes (EBL, operation time, and total and major complications). Full article

Background/Objectives: There is an urgent need for comparative analyses of the intraoperative, oncological, and functional outcomes of different surgical robotic platforms. We aimed to compare the outcomes of RARP performed at a tertiary referral robotic centre with the novel Hugo^TM RAS system with those performed with a daVinci surgical system, which is considered the reference standard. Methods: We analysed the data of 400 patients undergoing RARP ± pelvic lymph node dissection between 2021 and 2023, using propensity score (PS) matching to correct for treatment selection bias. All procedures were performed by three surgeons with Hugo^TM RAS or daVinci. Results: The PS-matched cohort included 198 patients with 99 matched pairs, balanced for all covariates. Positive surgical margins (PSMs) were found in 22.2% and 25.3% (p = 0.616) of patients, respectively, in the Hugo^TM RAS and daVinci groups. No significant differences were found for other important perioperative outcomes, including median (1st–3rd q) operative time (170 (147.5–195.5) vs. 166 (154–202.5) min; p = 0.540), median (1st–3rd q) estimated blood loss (EBL) (100 (100–150) vs. 100 (100–150) ml; p = 0.834), Clavien–Dindo (CD) ≥ 2 complications (3% vs. 4%; p = 0.498), and social continence at 3 months (73.7% vs. 74.7%; p = 0.353). In multiple analyses, no associations were found between surgical outcomes (PSM, length of PSM, operative time, EBL, length of catheterization, length of hospital stay, social continence at three months after surgery, and CD ≥ 2 complications) and the robotic platform. Conclusions: Our findings demonstrate that Hugo^TM RAS enables surgeons to safely and effectively transfer the level of proficiency they reached during their previous experience with the daVinci systems. Full article

Aims: To compare the oncological outcomes of patients with high-risk localized prostate cancer undergoing nerve-sparing and non-nerve-sparing robot-assisted radical prostatectomy (RARP). Methods: Between November 2002 and December 2018, we prospectively recorded the data of patients undergoing RARP for high-risk localized prostate cancer (PCa) at our tertiary referral center. NSS (nerve-sparing surgery) was carefully offered on the basis of the preoperative clinical characteristics of the patients and an intraoperative assessment. The patients were stratified into two groups: nerve-sparing and non-nerve-sparing groups (yes/no). Radical prostatectomies were performed by 10 surgeons with a robot-assisted technique using a daVinci^® surgical system. The primary oncological outcome evaluated was biochemical recurrence (BCR). The secondary oncological outcomes assessed were positive surgical margins (PSMs) and cancer-specific survival (CSS). Results: A total of 779 patients were included in the study: 429 (55.1%) underwent NSS while 350 (44.9%) underwent non-NSS. After a mean (±SD) follow-up of 192 (±14) months, 328 (42.1%) patients developed BCR; no significant difference was found between the NSS and non-NSS groups (156 vs. 172; p = 0.09). Both our univariable and multivariable analyses found that the nerve-sparing approach was not a predictor of BCR (p > 0.05). Kaplan–Mayer survival curves for BCR showed no significant difference among the non-NSS, unilateral NSS, and bilateral NSS groups (log rank test = 0.6). PSMs were reported after RARPs for 254 (32.6%) patients, with no significant difference between the NSS and non-NSS group (143 vs. 111; p = 0.5). In the subgroup of 15 patients who died during the follow-up period, mean (±SD) CSS was 70.5 (±26.1) months, with no significant difference between the NSS and non-NSS groups (mean CSS: 70.3 vs. 70.7 months). Conclusions: NSS does not appear to negatively impact the oncological outcomes of patients with high-risk PCa. Randomized clinical trials are needed to confirm our promising findings. Full article

Background: Partial nephrectomy (PN) is the preferred treatment for small, localized kidney tumors. Incomplete resection resulting in positive surgical margins (PSM) can occur after PN. The impact of PSM on the risk of recurrence and survival outcomes is not fully understood. We aimed to explore the relationship between PSM, the risk of recurrence and impact on survival after PN in a large multicenter cohort from Denmark. Methods: This was a retrospective cohort study including patients who underwent PN for renal cell carcinoma (RCC) at three departments in Denmark between 2010 and 2016. Data including pathological features, surgical techniques, and patient follow-up was retrieved from electronic medical health records and national databases. We used a combination of descriptive statistics, comparative analysis (comparisons were carried out by Mann–Whitney Test, independent Student’s t-test, or Pearson’s chi-Square Test), univariate and multivariate logistic regression analyses, and survival analysis methods. Results: A total of 523 patients were included, of which 48 (9.1%) had a PSM. Recurrence was observed in 55 patients (10.5%). Median follow-up time was 75 months. We found a lower incidence of PSM with robot-assisted PN (p = 0.01) compared to open or laparoscopic PN. PSM was associated with a higher risk of recurrence compared to negative margins in univariate analysis, but not multivariate analysis. However, the study was underpowered to describe this association with other risk factors. Overall survival did not differ between patients with PSM and negative margins. Conclusions: Our study presents further evidence on the negative impact of PSM on recurrence after PN for RCC, highlighting the importance of achieving NSM, thus potentially improving clinical outcomes. A surgical approach was found to be the only predictive factor influencing the risk of PSMs, with a reduced risk observed with robot-assisted laparoscopy. Full article

We compared the perioperative outcomes of open (ORC) vs. robot-assisted (RARC) radical cystectomy in the treatment of pT4a MIBC. In total, 212 patients underwent ORC (102 patients, Group A) vs. RARC (110 patients, Group B) for pT4a bladder cancer. Patients were prospectively followed and retrospectively reviewed. We assessed operative time, estimated blood loss (EBL), intraoperative and postoperative complications, length of stay, transfusion rate, and oncological outcomes. Preoperative features were comparable. The mean operative time was 232.8 vs. 189.2 min (p = 0.04), and mean EBL was 832.8 vs. 523.7 mL in Group A vs. B (p = 0.04). An intraoperative transfusion was performed in 32 (31.4%) vs. 11 (10.0%) cases during ORC vs. RARC (p = 0.03). The intraoperative complications rate was comparable. The mean length of stay was shorter after RARC (12.6 vs. 7.2 days, p = 0.02). Postoperative transfusions were performed in 36 (35.3%) vs. 13 (11.8%) cases (p = 0.03), and postoperative complications occurred in 37 (36.3%) vs. 29 (26.4%) patients in Groups A vs. B (p = 0.05). The positive surgical margin (PSM) rate was lower after RARC. No differences were recorded according to the oncological outcomes. ORC and RARC are feasible treatments for the management of pT4a bladder tumors. Minimally invasive surgery provides shorter operative time, bleeding, transfusion rate, postoperative complications, length of stay, and PSM rate. Full article