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Objective To perform an external validation of this RC-pentafecta. Method Between January 2014 and December 2019, 104 consecutive patients who underwent RARC with ICUD within 6 urological centers were analyzed retrospectively. Patients who simultaneously demonstrated negative soft tissue surgical margins (STSMs), a lymph node (LN) yield ≥ 16, absence of major (Clavien–Dindo grade III–V) 90-day postoperative complications, absence of UD-related long-term sequelae, and absence of 12-month clinical recurrence were considered to have achieved RC-pentafecta. A multivariable logistic regression model was used to measure predictors for achieving RC-pentafecta. We analyzed the influence of this RC-pentafecta on survival, and the impact ofthe surgical experience. Results Since 2014, 104 patients who had completed at least 12 months of follow-up were included. Over a mean follow-up of 18 months, a LN yield ≥ 16, negative STSMs, absence of major complications at 90 days, and absence of UD-related surgical sequelae and clinical recurrence at ≤ 12 months were observed in 56%, 96%, 85%, 81%, and 91% of patients, respectively, resulting in a RC-pentafecta rate of 39.4%. Multivariate analysis showed that age was an independent predictor of pentafecta achievement (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.90. 0.99; p = 0.04). The surgeon experience had an impact on the validation of the criteria. Conclusion This study confirmed that the RC-pentafecta is reproducible and could be externally used for the outcome assessment after RARC with ICUD. Therefore, the RC-pentafecta could be a useful tool to assess surgical success and its impact on different outcomes.

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NAC in LR patients was significantly associated with greater odds of finding pT1 disease at RC (OR 2.62; p<0.001) as well as pT0 status (OR 2.82; p<0.001); however, receipt of NAC in LR patients was not associated with a significant difference in 5-year cancer-specific survival (65% vs 68%; p¼0.31).CONCLUSIONS: Our results validate the proposed risk groups for patients with MIBC and support the use of NAC for HR patients. Moreover, we noted that, while NAC in LR patients was associated with a higher likelihood of favorable pathologic outcomes, only a minority (4.7%) of LR patients treated with up front RC were upstaged but unable to receive adjuvant chemotherapy due to postoperative complications, and receipt of NAC in LR patients was not associated with improved survival.

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