Current status of robotic assisted radical cystectomy with intracorporeal ileal neobladder for bladder cancer

Fahmy, Omar; Asri, Khairul; Schwentner, Christian; Stenzl, Arnulf; Gakis, Georgios

doi:10.1002/jso.24007

Cited by 12 publications

(5 citation statements)

References 20 publications

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“…Given the limited therapy choices for the vast majority of patients and the promising results of immune checkpoint inhibitors (ICIs) in other advanced diseases such as melanoma and lung cancer, there is a growing emphasis on treating prostate cancer with ICIs [8,9]. Although immune checkpoint blockade has been shown to be effective in urothelial and renal-cell carcinomas [10,11], prostate cancer has a more immunosuppressive microenvironment than these other genitourinary malignancies, suggesting that mCRPC may be less susceptible to immune checkpoint blockade [12,13].…”

Section: Introductionmentioning

confidence: 99%

Oncological Response and Predictive Biomarkers for the Checkpoint Inhibitors in Castration-Resistant Metastatic Prostate Cancer: A Systematic Review and Meta-Analysis

Fahmy

Alhakamy

Khairul-Asri

et al. 2021

JPM

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Recently, checkpoint inhibitors have been investigated in metastatic prostate cancer, however their overall effect is unclear and needs to be further investigated. Objectives: The aim of this systematic review is to investigate the oncological response of metastatic castration-resistant prostate cancer patients to immune checkpoint inhibitors. Methods: Based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement, a systematic review of the literature was conducted through online electronic databases and the American Society of Clinical Oncology (ASCO) Meeting Library. Eligible publications were selected after a staged screening and selection process. RevMan 5.4 software was employed to run the quantitative analysis and forest plots. Risk of bias assessment was conducted using the Cochrane tool and Newcastle–Ottawa Scale for the randomized and non-randomized trials, respectively. Results: From the 831 results retrieved, 8 studies including 2768 patients were included. There was no significant effect on overall survival (OS) (overall response (OR) = 0.98; Z = 0.42; p = 0.67). Meanwhile, progression-free survival (PFS) was significantly better with immune checkpoint inhibitors administration (OR = 0.85; Z = 3.9; p < 0.0001). The subgroup analysis for oncological outcomes based on programmed death ligand 1 (PD-L1) positivity status displayed no significant effect, except on prostate-specific antigen response rate (PSA RR) (OR = 3.25; Z = 2.29; p = 0.02). Based on DNA damage repair (DDR), positive patients had a significantly better PFS and a trend towards better OS and overall response rate (ORR); the ORR was 40% in positive patients compared to 20% in the negative patients (OR = 2.46; Z = 1.3; p = 0.19), while PSA RR was 23.5% compared to 14.3% (OR = 1.88; Z = 0.88; p = 0.38). Better PFS was clearly associated with DDR positivity (OR = 0.70; Z = 2.48; p = 0.01) with a trend towards better OS in DDR positive patients (OR = 0.71; Z = 1.38; p = 0.17). Based on tumor mutation burden (TMB), ORR was 46.7% with high TMB versus 8.8% in patients with low TMB (OR = 11.88; Z = 3.0; p = 0.003). Conclusions: Checkpoint inhibitors provide modest oncological advantages in metastatic castration-resistant prostate cancer. There are currently no good predictive indicators that indicate a greater response in some patients.

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Section: Introductionmentioning

confidence: 99%

Oncological Response and Predictive Biomarkers for the Checkpoint Inhibitors in Castration-Resistant Metastatic Prostate Cancer: A Systematic Review and Meta-Analysis

Fahmy

Alhakamy

Khairul-Asri

et al. 2021

JPM

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“…While a gold standard for neobladder configuration has not been established, several centers described their techniques for creating an intracorporeal ileal neobladder. The Studer neobladder is the most commonly performed type of ileal neobladder (18,19). Tan et al (9) reported their technique of pyramid neobladder.…”

Section: Discussionmentioning

confidence: 99%

Robot-assisted radical cystectomy with totally intracorporeal neobladder diversion: perioperative, oncologic, and functional outcomes

Xia

et al. 2020

Transl Androl Urol

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Background: The use of robot-assisted radical cystectomy (RARC) has increased rapidly in the past decade. However, reports of intracorporeal neobladder diversion remain limited. This article aimed to provide the surgical steps for RARC with totally intracorporeal neobladder diversion and the present perioperative, oncologic, and functional outcomes.Methods: Between June 2017 and January 2020, RARC with intracorporeal neobladder diversion was performed in 12 male patients. Perioperative variables, pathologic data, early and late complications, urinary continence, potency, and recurrence-free survival were evaluated as outcome measures. Results:The surgery was successful in all cases without open conversion. The median operative time, estimated blood loss, and postoperative hospital stay were 419 min (range, 315-640 min), 400 mL (range, 250-1,200 mL), and 14.5 days (range, 9-25 days), respectively. No positive surgical margins nor lymph nodes were observed. Eleven minor (grades 1 and 2) and one major (grades 3-5) complications were found in the early (0-30 days) period and six minor and one major complications in the late (>30 days) period. The median follow-up time was 13.1 months (range, 5.4-32.0 months), and two patients died due to metastatic disease. At 6 months after surgery, the daytime continence rate was 90.0%, while the nighttime continence rate was 80.0%. Only two patients (16.7%) reported capability of potency. The study was limited by a small sample size and short follow-up.Conclusions: RARC with intracorporeal neobladder is a complex procedure but technically feasible with acceptable oncologic and functional outcomes. Studies with long-term follow ups and increased number of cases and randomized trials are indispensable to assess the potential of this technique.

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“…Menon et al [66] firstly reported RARC in 2003. Since then, the research results of many scholars [67][68][69] have shown that compared with ORC and LRC, RARC can complete a more detailed anatomy, which can cure tumors, preserve function and control urine to achieve better result. Reducing the operative time is considered to be beneficial for surgeons to improve the efficiency of surgery, and for patients to reduce estimated blood loss, accelerate postoperative recovery, and reduce complications.…”

Section: Discussionmentioning

confidence: 99%

Bayesian network analysis of open, laparoscopic and Robot-assisted Radical cystectomy.

Lin¹,

Chen²,

Hu³

et al. 2020

Preprint

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Background We performed the conventional meta-analysis and network meta-analysis to evaluate the safety and efficacy of Robot-assisted Radical cystectomy (RARC) versus laparoscopic radical cystectomy (LRC) versus open radical cystectomy (ORC) for bladder cancer (BCa). Methods A systematic search of PubMed, Cochrane Library and Embase was performed up to until Dec 20, 2019. Outcome indexes include: oncologic outcomes: the recurrence rate, mortality; pathologic outcomes: Lymph node yield (LNY), Positive lymph node (PLN), positive surgical margins (PSM); perioperative outcomes: operating time (OP), estimated blood loss (EBL), blood transfusion rate, the length of hospital stay, and the time to regular diet. And Postoperative 90-day complications. Results 59 articles describing 8 RCTs, 25 Prospective study, 26 Retrospective study (6944 patients) were analyzed. No significant differences were found between RARC, LEC and ORC in two oncologic outcomes: the recurrence rate and mortality. However, for the recurrence rate, patients with LRC has the highest probability, ORC has the second highest probability, and RARC has the lowest probability. For the mortality, patients with ORC has the highest probability, LRC has the second probability, and RARC has the lowest probability. In three pathologic outcomes: direct meta-analysis indicates that ORC is more than RARC or LRC in PSM and RARC is more than ORC in LNY. On the other hand, network meta-analysis indicates that ORC is more than RARC in PSM. No significant differences were found between RARC, LEC and ORC in other pathologic outcomes: LNY and PLN. for LNY, patients with RARC has the highest probability, ORC has the second highest probability, and LRC has the lowest probability by our network meta-analysis. For PLN, patients with ORC has the highest probability, LRC has the second probability, and RARC has the lowest probability by our network meta-analysis. With respect to perioperative outcomes, direct meta-analysis indicates that RARC is shorter time than LRC or ORC in OP. On the other hand, network meta-analysis indicates that patients with ORC have significantly longer OP than LRC or RARC. Direct meta-analysis and network meta-analysis both indicate that ORC is more than RARC or LRC in EBL, ORC is longer than RARC or LRCConclusion The conventional meta-analysis and network meta-analysis suggest that RARC is a safest and most effective surgical approach in the treatment of BCa and LRC rankes second. However, large sample size and more high-quality studies are still needed to further improve and verify.

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Current status of robotic assisted radical cystectomy with intracorporeal ileal neobladder for bladder cancer

Cited by 12 publications

References 20 publications

Oncological Response and Predictive Biomarkers for the Checkpoint Inhibitors in Castration-Resistant Metastatic Prostate Cancer: A Systematic Review and Meta-Analysis

Oncological Response and Predictive Biomarkers for the Checkpoint Inhibitors in Castration-Resistant Metastatic Prostate Cancer: A Systematic Review and Meta-Analysis

Robot-assisted radical cystectomy with totally intracorporeal neobladder diversion: perioperative, oncologic, and functional outcomes

Bayesian network analysis of open, laparoscopic and Robot-assisted Radical cystectomy.

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