Login to Access Video or Poster Abstract: MP21-13
Sources of Funding: Roswell Park Alliance Foundation

Introduction

Lack of tactile feedback and potential higher risk of positive margins may advocate against the use of Robot-assisted Radical Cystectomy (RARC) for Locally advanced disease (LAD). We evaluated the quality of RARC in patients with LAD and compared it to organ-confined disease (OCD)

Methods

Retrospective review of 421 consecutive RARCs between 2005 and 2015 was performed. Patients with LAD (>=pT3 and/or N+) were compared with OCD (<=pT2/N0). Validated Quality Cystectomy Score (QCS) based on 4 sets of quality metrics was used to compare surgical performance in both groups: [I- Preoperative (Administration of Neoadjuvant Chemotherapy); II- Operative (Overall operative time (< 6.5 hours) and estimated blood loss less <500 ml); III- Pathologic (Negative Soft Tissue Surgical Margins and Lymph Node Yield>20); and IV- Peri-operative (No high grade complications, Readmission or Mortality within 30-d)]. Star Scores were assigned according to the number of criteria achieved. Kaplan Meier method was used to compute recurrence free (RFS), cancer-specific (CSS) and overall survival (OS) rates. Cox proportional hazards model were fit to evaluate predictors of survival.

Results

52% had LAD. They had fewer neobladders (3% vs 12%, p<0.001), received adjuvant chemotherapy more frequently (34% vs 4%, p<0.001), and experienced higher mortality within 90 d of RARC (8% vs 1%, p=0.001). LAD patients showed more positive surgical margins (18% vs 2%, p<0.001) and developed recurrences more frequently (41% vs 13%, p<0.001). There was no significant difference in complications or readmissions. Patients with OCD exhibited better 3-year RFS, DSS and OS (85% vs 47%, 96% vs 65% and 81% vs 28%, respectively) (Figure 1). 91% of OCD patients achieved >=3 stars in comparison to 81% in LAD (Table 1). For OCD, patients who achieved star score of 3 or 4 remained stable (approximately 90%), while for LAD, it improved from 72% to 93% between 2005 and 2015.

Conclusions

Despite receiving comparable quality of surgical care, patients with LAD exhibited worse RFS, DSS and OS.

Funding

Roswell Park Alliance Foundation