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Robotic versus open radical cystectomy throughout the learning phase: insights from a real-life multicenter study

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Abstract

Background and objectives

Robot-assisted radical cystectomy (RARC) has been shown to be non-inferior to open radical cystectomy (ORC) for the treatment of bladder cancer (BC). However, most data on RARC come from high-volume surgeons at high-volume centers. The objective of the study was to compare perioperative and mid-term oncologic outcomes of RARC versus ORC in a real-life cohort of patients treated by surgeons starting their experience with RARC.

Materials and methods

Data were prospectively collected from consecutive patients undergoing RARC and ORC at five referral Centers between 2010 and 2016 by five surgeons (one per center) with no prior experience in RARC. Patients with high-risk non-muscle-invasive or organ-confined muscle-invasive (T2N0M0) bladder cancer were considered for RARC. The main study endpoints were perioperative outcomes, postoperative surgical complications, and mid-term oncologic outcomes.

Results

Overall, 124 and 118 patients underwent RARC and ORC, respectively. Baseline patients’ and tumors’ characteristics were comparable between the two groups. Yet, the proportion of patients receiving neoadjuvant chemotherapy was significantly higher in the RARC cohort. Median operative time was significantly higher, while median EBL, LOH, and transfusion rates were significantly lower after RARC. Median number of lymph nodes removed was significantly higher after RARC. All other histopathological outcomes, as well as the rate of early (< 30 days) and late postoperative complications, were comparable to ORC. At a median follow-up of 2 years, 29 (23%) and 41 (35%) patients developed disease recurrence (p = 0.05), while 20 (16%) and 37 (31%) died of bladder cancer (p = 0.005) after RARC and ORC, respectively.

Conclusions

With proper patient selection, RARC was non-inferior to ORC throughout the surgeons’ learning phase. Yet, the observed differences in oncologic outcomes suggest selection bias toward adoption of RARC for patients with more favorable disease characteristics.

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Authors and Affiliations

  1. Sorbonne University, Hopital Pitié Salpétrière, Urology, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France

    Louis Lenfant, Riccardo Campi, Jérôme Parra, Christophe Vaessen & Morgan Rouprêt

  2. Department of Urology, Careggi Hospital, University of Florence, Florence, Italy

    Riccardo Campi

  3. Department of Urology, Pontchaillou Hospital, CHU RENNES, Rennes, France

    Vivien Graffeille & Gregory Verhoest

  4. Department of Urology, Henri Mondor Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP) CHU Mondor, Faculté de Médecine, Créteil, France

    Alexandra Masson-Lecomte, Dimitri Vordos & Alexandre de La Taille

  5. Department of Urology, Andrology and Renal Transplantation, CHU Rangueil, Paul-Sabatier University, 1, av J Pouilhès, 31059, Toulouse Cedex, France

    Mathieu Roumiguie & Marine Lesourd

  6. Hôpital privé d’Antony, 1 rue Velpeau, 92160, Antony, France

    Lionel Taksin

  7. Clinique Pasteur, 45 Avenue de Lombez, 31300, Toulouse, France

    Vincent Misraï

  8. Department of Biostatistics, Groupe Hospitalo-Universitaire EST, Faculté de Médecine Pierre et Marie Curie, Pitié-Salpétrière Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), University Paris Sorbonne, Paris, France

    Benjamin Granger

  9. Department of Urology, Clinique St Jean du Languedoc, Toulouse, France

    Guillaume Ploussard

Authors
  1. Louis Lenfant
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  2. Riccardo Campi
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  3. Jérôme Parra
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  4. Vivien Graffeille
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  5. Alexandra Masson-Lecomte
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  6. Dimitri Vordos
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  7. Alexandre de La Taille
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  8. Mathieu Roumiguie
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  9. Marine Lesourd
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  10. Lionel Taksin
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  11. Vincent Misraï
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  12. Benjamin Granger
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  13. Guillaume Ploussard
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  14. Christophe Vaessen
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  15. Gregory Verhoest
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  16. Morgan Rouprêt
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Contributions

LL: protocol/project development, data collection or management, data analysis, and manuscript writing/editing. RC: data analysis, and manuscript writing/editing. JP: protocol/project development. VG: data collection or management. AM-L: data collection or management. DV: data collection or management. ALT: protocol/project development. MR: protocol/project development. ML: data collection or management. LT: data collection or management. VM: data collection or management. BG: data analysis. GP: protocol/project development, and data collection or management. CV: protocol/project development. GV: protocol/project development, and manuscript writing/editing. MR: protocol/project development, and manuscript writing/editing.

Corresponding author

Correspondence to Morgan Rouprêt.

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Informed consent was obtained from all individual participants included in the study.

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Lenfant, L., Campi, R., Parra, J. et al. Robotic versus open radical cystectomy throughout the learning phase: insights from a real-life multicenter study. World J Urol 38, 1951–1958 (2020). https://doi.org/10.1007/s00345-019-02998-y

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  • DOI: https://doi.org/10.1007/s00345-019-02998-y

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