Efficacy of Robot-assisted Radical Cystectomy in Advanced Bladder Cancer: Results from the International Radical Cystectomy Consortium (IRCC)

Ali Al-Daghmin; Eric C Kauffman; Yi Shi; Ketan Badani; M Derya Balbay; Erdem Canda; Prokar Dasgupta; Reza Ghavamian; Robert Grubb; Ashok Hemal; Jihad Kaouk; Adam S Kibel; Thomas Maatman; Mani Menon; Alex Mottrie; Kenneth Nepple; John G Pattaras; James O Peabody; Vassilis Poulakis; Raj Pruthi; Joan Palou Redorta; Koon-Ho Rha; Lee Richstone; Francis Schanne; Douglas S Scherr; Stefan Siemer; Michael Stöckle; Eric M Wallen; Alon Weizer; Peter Wiklund; Timothy Wilson; Gregory Wilding; Michael Woods; Khurshid A Guru

doi:10.1111/bju.12569

Efficacy of Robot-assisted Radical Cystectomy in Advanced Bladder Cancer: Results from the International Radical Cystectomy Consortium (IRCC)

Ali Al-Daghmin, Eric C Kauffman, Yi Shi, Ketan Badani, M Derya Balbay, Erdem Canda, Prokar Dasgupta, Reza Ghavamian, Robert Grubb, Ashok Hemal, Jihad Kaouk, Adam S Kibel, Thomas Maatman, Mani Menon, Alex Mottrie, Kenneth Nepple, John G Pattaras, James O Peabody, Vassilis Poulakis, Raj PruthiJoan Palou Redorta, Koon-Ho Rha, Lee Richstone, Francis Schanne, Douglas S Scherr, Stefan Siemer, Michael Stöckle, Eric M Wallen, Alon Weizer, Peter Wiklund, Timothy Wilson, Gregory Wilding, Michael Woods, Khurshid A Guru

King's College London

Roswell Park Cancer Institute

Research output: Contribution to journal › Article › peer-review

12 Citations (Scopus)

Abstract

Objectives
To characterize the surgical feasibility and outcomes of robot-assisted radical cystectomy (RARC) for pathologic T4 bladder cancer.

Subjects/Patients
Retrospective evaluation of a prospectively maintained IRCC database was conducted for 1118 patients who underwent RARC between 2003 and 2012. We dichotomized patients based on pathologic stage (≤pT3 versus pT4) and evaluated demographic, operative and pathologic variables in relation to morbidity and mortality.

Results
Total of 1000 ≤pT3 and 118 pT4 patients were evaluated. pT4 patients were on average older than ≤pT3 patients ( p=0.001). Median operative time and blood loss were 386 min, and 350 cc vs. 396 min and 350 cc for p T4 and ≤ p T3, respectively. Complication rate was similar (54% vs. 58%; P = 0.64) among ≤pT3 and pT4 patients, respectively. The overall 30 and 90-day mortality rate was 0.4% and 1.8% versus 4.2% and 8.5% for ≤pT3 versus pT4 patients (P = <0.001), respectively. Body mass index (BMI), American Society of Anesthesiology score (ASA), length of hospital stay (LOS) >10 days, and 90-day readmission were significantly associated with complications in pT4 patients. Meanwhile, BMI, LOS >10 days, grade 3-5 complications, 90-day readmission, smoking, previous abdominal surgery and neoadjuvant chemotherapy were significantly associated with mortality in pT4 patients. On multivariate analysis, BMI was an independent predictor of complications in pT4 patients, but not for mortality.

Conclusions
RARC for pT4 bladder cancer is surgically feasible but entails significant morbidity and mortality. BMI was independent predictor of complications in pT4 patients.

Original language	English
Pages (from-to)	98-103
Number of pages	6
Journal	BJU International
Volume	114
Issue number	1
DOIs	https://doi.org/10.1111/bju.12569
Publication status	E-pub ahead of print - Jul 2014

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Al-Daghmin, A., Kauffman, E. C., Shi, Y., Badani, K., Balbay, M. D., Canda, E., Dasgupta, P., Ghavamian, R., Grubb, R., Hemal, A., Kaouk, J., Kibel, A. S., Maatman, T., Menon, M., Mottrie, A., Nepple, K., Pattaras, J. G., Peabody, J. O., Poulakis, V., ... Guru, K. A. (2014). Efficacy of Robot-assisted Radical Cystectomy in Advanced Bladder Cancer: Results from the International Radical Cystectomy Consortium (IRCC). BJU International, 114(1), 98-103. Advance online publication. https://doi.org/10.1111/bju.12569

@article{3d5c0b0da7c34485b490e95a48197d85,

title = "Efficacy of Robot-assisted Radical Cystectomy in Advanced Bladder Cancer: Results from the International Radical Cystectomy Consortium (IRCC)",

abstract = "ObjectivesTo characterize the surgical feasibility and outcomes of robot-assisted radical cystectomy (RARC) for pathologic T4 bladder cancer.Subjects/PatientsRetrospective evaluation of a prospectively maintained IRCC database was conducted for 1118 patients who underwent RARC between 2003 and 2012. We dichotomized patients based on pathologic stage (≤pT3 versus pT4) and evaluated demographic, operative and pathologic variables in relation to morbidity and mortality.ResultsTotal of 1000 ≤pT3 and 118 pT4 patients were evaluated. pT4 patients were on average older than ≤pT3 patients ( p=0.001). Median operative time and blood loss were 386 min, and 350 cc vs. 396 min and 350 cc for p T4 and ≤ p T3, respectively. Complication rate was similar (54% vs. 58%; P = 0.64) among ≤pT3 and pT4 patients, respectively. The overall 30 and 90-day mortality rate was 0.4% and 1.8% versus 4.2% and 8.5% for ≤pT3 versus pT4 patients (P = <0.001), respectively. Body mass index (BMI), American Society of Anesthesiology score (ASA), length of hospital stay (LOS) >10 days, and 90-day readmission were significantly associated with complications in pT4 patients. Meanwhile, BMI, LOS >10 days, grade 3-5 complications, 90-day readmission, smoking, previous abdominal surgery and neoadjuvant chemotherapy were significantly associated with mortality in pT4 patients. On multivariate analysis, BMI was an independent predictor of complications in pT4 patients, but not for mortality.ConclusionsRARC for pT4 bladder cancer is surgically feasible but entails significant morbidity and mortality. BMI was independent predictor of complications in pT4 patients.",

author = "Ali Al-Daghmin and Kauffman, {Eric C} and Yi Shi and Ketan Badani and Balbay, {M Derya} and Erdem Canda and Prokar Dasgupta and Reza Ghavamian and Robert Grubb and Ashok Hemal and Jihad Kaouk and Kibel, {Adam S} and Thomas Maatman and Mani Menon and Alex Mottrie and Kenneth Nepple and Pattaras, {John G} and Peabody, {James O} and Vassilis Poulakis and Raj Pruthi and Redorta, {Joan Palou} and Koon-Ho Rha and Lee Richstone and Francis Schanne and Scherr, {Douglas S} and Stefan Siemer and Michael St{\"o}ckle and Wallen, {Eric M} and Alon Weizer and Peter Wiklund and Timothy Wilson and Gregory Wilding and Michael Woods and Guru, {Khurshid A}",

year = "2014",

month = jul,

doi = "10.1111/bju.12569",

language = "English",

volume = "114",

pages = "98--103",

journal = "BJU International",

issn = "1464-4096",

publisher = "Wiley-Blackwell",

number = "1",

}

Al-Daghmin, A, Kauffman, EC, Shi, Y, Badani, K, Balbay, MD, Canda, E, Dasgupta, P, Ghavamian, R, Grubb, R, Hemal, A, Kaouk, J, Kibel, AS, Maatman, T, Menon, M, Mottrie, A, Nepple, K, Pattaras, JG, Peabody, JO, Poulakis, V, Pruthi, R, Redorta, JP, Rha, K-H, Richstone, L, Schanne, F, Scherr, DS, Siemer, S, Stöckle, M, Wallen, EM, Weizer, A, Wiklund, P, Wilson, T, Wilding, G, Woods, M & Guru, KA 2014, 'Efficacy of Robot-assisted Radical Cystectomy in Advanced Bladder Cancer: Results from the International Radical Cystectomy Consortium (IRCC)', BJU International, vol. 114, no. 1, pp. 98-103. https://doi.org/10.1111/bju.12569

TY - JOUR

T1 - Efficacy of Robot-assisted Radical Cystectomy in Advanced Bladder Cancer

T2 - Results from the International Radical Cystectomy Consortium (IRCC)

AU - Al-Daghmin, Ali

AU - Kauffman, Eric C

AU - Shi, Yi

AU - Badani, Ketan

AU - Balbay, M Derya

AU - Canda, Erdem

AU - Dasgupta, Prokar

AU - Ghavamian, Reza

AU - Grubb, Robert

AU - Hemal, Ashok

AU - Kaouk, Jihad

AU - Kibel, Adam S

AU - Maatman, Thomas

AU - Menon, Mani

AU - Mottrie, Alex

AU - Nepple, Kenneth

AU - Pattaras, John G

AU - Peabody, James O

AU - Poulakis, Vassilis

AU - Pruthi, Raj

AU - Redorta, Joan Palou

AU - Rha, Koon-Ho

AU - Richstone, Lee

AU - Schanne, Francis

AU - Scherr, Douglas S

AU - Siemer, Stefan

AU - Stöckle, Michael

AU - Wallen, Eric M

AU - Weizer, Alon

AU - Wiklund, Peter

AU - Wilson, Timothy

AU - Wilding, Gregory

AU - Woods, Michael

AU - Guru, Khurshid A

PY - 2014/7

Y1 - 2014/7

N2 - ObjectivesTo characterize the surgical feasibility and outcomes of robot-assisted radical cystectomy (RARC) for pathologic T4 bladder cancer.Subjects/PatientsRetrospective evaluation of a prospectively maintained IRCC database was conducted for 1118 patients who underwent RARC between 2003 and 2012. We dichotomized patients based on pathologic stage (≤pT3 versus pT4) and evaluated demographic, operative and pathologic variables in relation to morbidity and mortality.ResultsTotal of 1000 ≤pT3 and 118 pT4 patients were evaluated. pT4 patients were on average older than ≤pT3 patients ( p=0.001). Median operative time and blood loss were 386 min, and 350 cc vs. 396 min and 350 cc for p T4 and ≤ p T3, respectively. Complication rate was similar (54% vs. 58%; P = 0.64) among ≤pT3 and pT4 patients, respectively. The overall 30 and 90-day mortality rate was 0.4% and 1.8% versus 4.2% and 8.5% for ≤pT3 versus pT4 patients (P = <0.001), respectively. Body mass index (BMI), American Society of Anesthesiology score (ASA), length of hospital stay (LOS) >10 days, and 90-day readmission were significantly associated with complications in pT4 patients. Meanwhile, BMI, LOS >10 days, grade 3-5 complications, 90-day readmission, smoking, previous abdominal surgery and neoadjuvant chemotherapy were significantly associated with mortality in pT4 patients. On multivariate analysis, BMI was an independent predictor of complications in pT4 patients, but not for mortality.ConclusionsRARC for pT4 bladder cancer is surgically feasible but entails significant morbidity and mortality. BMI was independent predictor of complications in pT4 patients.

AB - ObjectivesTo characterize the surgical feasibility and outcomes of robot-assisted radical cystectomy (RARC) for pathologic T4 bladder cancer.Subjects/PatientsRetrospective evaluation of a prospectively maintained IRCC database was conducted for 1118 patients who underwent RARC between 2003 and 2012. We dichotomized patients based on pathologic stage (≤pT3 versus pT4) and evaluated demographic, operative and pathologic variables in relation to morbidity and mortality.ResultsTotal of 1000 ≤pT3 and 118 pT4 patients were evaluated. pT4 patients were on average older than ≤pT3 patients ( p=0.001). Median operative time and blood loss were 386 min, and 350 cc vs. 396 min and 350 cc for p T4 and ≤ p T3, respectively. Complication rate was similar (54% vs. 58%; P = 0.64) among ≤pT3 and pT4 patients, respectively. The overall 30 and 90-day mortality rate was 0.4% and 1.8% versus 4.2% and 8.5% for ≤pT3 versus pT4 patients (P = <0.001), respectively. Body mass index (BMI), American Society of Anesthesiology score (ASA), length of hospital stay (LOS) >10 days, and 90-day readmission were significantly associated with complications in pT4 patients. Meanwhile, BMI, LOS >10 days, grade 3-5 complications, 90-day readmission, smoking, previous abdominal surgery and neoadjuvant chemotherapy were significantly associated with mortality in pT4 patients. On multivariate analysis, BMI was an independent predictor of complications in pT4 patients, but not for mortality.ConclusionsRARC for pT4 bladder cancer is surgically feasible but entails significant morbidity and mortality. BMI was independent predictor of complications in pT4 patients.

U2 - 10.1111/bju.12569

DO - 10.1111/bju.12569

M3 - Article

C2 - 24219170

SN - 1464-4096

VL - 114

SP - 98

EP - 103

JO - BJU International

JF - BJU International

IS - 1

ER -

Efficacy of Robot-assisted Radical Cystectomy in Advanced Bladder Cancer: Results from the International Radical Cystectomy Consortium (IRCC)

Abstract

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