Propensity-score-matched comparison of soft tissue surgical margins status between open and robotic-assisted radical cystectomy.

Abstract

INTRODUCTION:

The use of robotic-assisted radical cystectomy (RARC) is becoming more widespread. While its safety is accepted, its oncological efficacy as compared to the current standard, open radical cystectomy (ORC), remains debatable.

MATERIALS AND METHODS:

The aim of this study is to compare the rates of positive soft tissue surgical margins (STSM), between patients treated with RARC or ORC, using a large contemporaneous collaborative database. We included 2,536 patients with urothelial carcinoma of the bladder treated at 26 institutions. A propensity-score matching 1:1 was performed with 3 ORC patients matched to 1 RARC patient. The final cohort included 1,614 patients. Uni- and multivariable logistic regression analyses tested the impact of surgical technique on STSM status, before and after propensity-score matching.

RESULTS:

Overall, 870 (34%) patients underwent RARC and 1,666 (66%) ORC. The overall STSM rate was 11%; 10% in the ORC group and 13% in the RARC group. Within the propensity-score-matched cohort, the positive STSM rate were 14% and 13% in the ORC and RARC group, respectively (P = 0.1). In multivariable analysis, after propensity match RARC approach was not associated with the risk of a positive STSM (P = 0.1). These results were confirmed in the subgroup of patients with pathologic non-organ-confined or organ-confined diseases.

CONCLUSIONS:

While treatment with RARC is associated with a higher absolute rate of STSM, the difference did not remain after adjustment for the effects of other established prognostic factors. Results from ongoing trials are awaited to assess the validity of these findings.

• Authors: Marco Moschini, Francesco Soria, Romain Mathieu, Evanguelos Xylinas, David D'Andrea, Wei Shen Tan, John D Kelly, Giuseppe Simone, Gabriele Tuderti, Anoop Meraney, Suprita Krishna, Badrianath Konety, Stefania Zamboni, Philipp Baumeister, Agostino Mattei, Alberto Briganti, Francesco Montorsi, Michele Galucci, Michael Rink, Pierre I Karakiewicz, Morgan Rouprêt, Atiqullah Aziz, Matt Perry, Edward Rowe, Anthony Koupparis, Wassim Kassouf, Douglas S Scherr, Guillaume Ploussard, Stephen A Boorjian, Prasanna Sooriakumaran, Shahrokh F Shariat, European Association of Urology – Young Academic Urologists (EAU-YAU), Urothelial Carcinoma Working Group
• Journal: Urologic oncology (Urol Oncol) Vol. 37 Issue 3 Pg. 179.e1-179.e7 (03 2019) ISSN: 1873-2496 [Electronic] United States
• PMID: 30446442 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2018 Elsevier Inc. All rights reserved.

Topics

• Aged
• Carcinoma, Transitional Cell (pathology, therapy)
• Chemotherapy, Adjuvant
• Cystectomy (adverse effects, methods)
• Female
• Follow-Up Studies
• Humans
• Length of Stay
• Lymph Node Excision
• Male
• Margins of Excision
• Middle Aged
• Postoperative Complications (epidemiology, etiology)
• Propensity Score
• Retrospective Studies
• Robotic Surgical Procedures (adverse effects, methods)
• Treatment Outcome
• Urinary Bladder (pathology, surgery)
• Urinary Bladder Neoplasms (pathology, therapy)