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Quality of surgical care can impact survival in patients with bladder cancer after robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium

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Youssef Ahmed, Ahmed A. Hussein, Paul R. May, Basel Ahmad, Amir Khan, John Benkowski, Ayesha Durrani, Saira Khan, Justen Kozlowski, Matthias Saar, Carl J. Wijburg, Lee Richstone, Andrew Wagner, Bertram Yuh, Joan Palou Redorta, Prokar Dasgupta, Mohammad Shamim Khan, Mani Menon, James O. Peabody, Abolfazl Hosseini & 16 more Franco Gaboardi, Giovannalberto Pini, Francis Schanne, Alexandre Mottrie, Koon ho Rha, Ashok Hemal, Michael Stockle, John Kelly, Wei Shen Tan, Thomas J. Maatman, Vassilis Poulakis, Jihad Kaouk, Abdullah Erdem Canda, Mevlana Derya Balbay, Peter Wiklund, Khurshid A. Guru

Original languageEnglish
Article number22
JournalAfrican Journal of Urology
Volume26
Issue number1
DOIs
Publication statusPublished - 1 Dec 2020

King's Authors

Abstract

Background: Although pathological factors remain the main determinate of survival for patients with bladder cancer, quality of surgical care is crucial for satisfactory outcomes. Using a validated quality score, we investigated the impact of surgical factors on the overall survival (OS), recurrence-free survival (RFS) and disease-specific survival (DSS) in patients with locally advanced and organ-confined disease (OCD). Retrospective review of IRCC database includes 2460 patients from 29 institutions across 11 countries. The final cohort included 1343 patients who underwent RARCs between 2005 and 2016. Patients with locally advanced disease (LAD) (> pT2 and/or N +) were compared with OCD (≤ pT2/N0). Validated Quality Cystectomy Score (QCS) based on four sets of quality metrics was used to compare surgical performance. Kaplan–Meier method was used to compute RFS, CSS and OS rates. Multivariable stepwise logistic regression was used to evaluate variables associated with RFS, DSS and OS. Results: 48% had LAD. When compared to patients with OCD, they received neobladders less frequently (17% vs. 28%, p < 0.001) and experienced higher estimated blood loss (513 vs. 376 ml, p = 0.05). Postoperatively, more patients in the LAD group received adjuvant chemotherapy (24% vs. 4%, p < 0.001) and positive surgical margins (14% vs. 2%, p < 0.001) and had higher 90-day mortality (6% vs. 2%, p < 0.001). On multivariable analysis, female gender, higher QCS score, intracorporeal diversion, pT stage, positive lymph node status and recurrence are considered as predictors of survival. Patients with OCD exhibited better RFS, DSS and OS than patients with LAD. For patients with OCD, higher QCS was associated with improved OS but not RFS or DSS. On the other hand, patients with LAD and higher QCS exhibited higher RFS, DSS and OS when compared to those with lower QCS. Conclusion: Quality of surgical care can affect disease control and OS in patients with bladder cancer treated with robot-assisted radical cystectomy.

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