To investigate the oncological significance of robot assisted radical cystectomy (RARC)-related pentafecta among patients with bladder cancer.
Using the KORAC database (containing data from 12 centers), data from 730 patients who underwent RARC between April 2007 and May 2019 were prospectively collected and retrospectively analyzed. Pentafecta was achieved if patients met all of the following criteria: 1) negative soft tissue surgical margin, 2) ≥ 16 Lymph node (LN) removed, 3) no major complications (Clavien-Dindo grade 3-5) within 90 days and 4) no clinical recurrence within the first 12 months and 5) no uretero-enteric stricture. Patients were divided into two groups according to pentafecta attainment and followed by a comparison of overall survival (OS) and cancer specific survival (CSS) using the multivariate Cox proportional analysis.
Among the 730 patients included in this analysis, 208 (28.5%) attained RARC-pentafecta; the remaining 522 (71.5%) did not. The mean age of subjects was 64.67 years, 85.1% were males with bladder cancer, 53.6% received a conduit, 37.7% received orthotopic neobladders and the total complication rate was 57.8%. Those who attained pentafecta 1) received more neobladders (p=0.039), 2) were more likely to be treated with the intracorporeal technique (p < 0.001), 3) had longer operating times (p=0.020) and 4) had longer console time (p = 0.021) compared with those who did not attain pentafecta. Over a mean of 31.1 months of follow up, the pentafecta attainment group had significantly higher OS and CSS rates compared with the not-attaiment group, respectively [10 year OS: 70.4% vs. 58.1%, respectively (p=0.016); 10 year CSS: 87.8% vs. 70.0% (p = 0.036)]. Multivariate analysis revealed that RARC-pentafecta was a significant predictor of overall death (HR = 0.561, p = 0.038).
Patients who attained RARC-pentafecta had significant better survival outcomes compared with those who did not attain pentafecta. Our criteria could be the guideline to standard the surgical quality of RARC. In the future, a similar study using an independent cohort is warranted to help confirm the results achieved here.
BJU international. 2020 Jul 18 [Epub ahead of print]
Jong Jin Oh, Sangchul Lee, Ja Hyeon Ku, Tae Gyun Kwon, Tae-Hwan Kim, Seung Hyun Jeon, Sang Hyup Lee, Jong Kil Nam, Wan Seok Kim, Byong Chang Jeong, Ji Youl Lee, Sung Hoo Hong, Koon Ho Rha, Woong Kyu Han, Won Sik Ham, Young Goo Lee, Yong Seong Lee, Sung Yul Park, Young Eun Yoon, Sung Gu Kang, Seok Ho Kang, Korean Robot Assisted Radical Cystectomy (KORARC) Study Group
Department of Urology, Seoul National University Bundang Hospital, Seongnam, Korea., Department of Urology, Seoul National University College of Medicine, Seoul, Korea., Department of Urology, Kyungpook National University School of Medicine, Daegu, Korea., Department of Urology, Kyung Hee University School of Medicine, Seoul, Korea., Department of Urology, Busan National University Yangsan Hospital, Yangsan, Korea., Department of Urology, Busan Paik Hospital, College of Medicine, Inje University, Busan, Korea., Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea., Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea., Department of Urology, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea., Department of Urology, Hallym University Kangnam Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea., Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea., Department of Urology, Hanyang University College of Medicine, Seoul, Korea., Department of Urology, Korea University College of Medicine, Seoul, Korea.