Oncological outcome according to attainment of pentafecta after robot‐assisted radical cystectomy in patients with bladder cancer included in the multicentre KORARC database

Abstract

Objectives To investigate the oncological significance of a robot‐assisted radical cystectomy (RARC)‐related pentafecta in patients with bladder cancer. Patients and Methods Using the KORARC database, which includes data from 12 centres, data from 730 patients who underwent RARC between April 2007 and May 2019 were prospectively collected and retrospectively analysed. Pentafecta was achieved if patients met all of the following criteria: (i) negative soft tissue surgical margin; (ii) ≥16 lymph nodes removed; (iii) no major complications (Clavien–Dindo grade 3–5) within 90 days; (iv) no clinical recurrence within the first 12 months; and (v) no ureteroenteric stricture. Patients were divided into two groups according to pentafecta attainment, and a comparison of overall survival (OS) and cancer‐specific survival (CSS) using multivariate Cox proportional analysis was then carried out. Results Of the 730 patients included in this analysis, 208 (28.5%) attained the RARC pentafecta; the remaining 522 (71.5%) did not. The mean age of the patients was 64.67 years, 85.1% were men, 53.6% received a conduit, 37.7% received orthotopic neobladders and the total complication rate was 57.8%. Those who attained the pentafecta received more neobladders (P = 0.039), were more likely to be treated with the intracorporeal technique (P < 0.001), had longer operating times (P = 0.020) and had longer console time (P = 0.021) compared with those who did not attain the pentafecta. Over a mean of 31.1 months of follow‐up, the pentafecta attainment group had significantly higher OS and CSS rates compared with the non‐attainment group (10‐year OS 70.4% vs 58.1%, respectively [P = 0.016]; 10‐year CSS 87.8% vs 70.0%, respectively [P = 0.036]). Multivariate analysis showed that the RARC pentafecta was a significant predictor of overall mortality (hazard ratio 0.561; P = 0.038). Conclusions Patients who attained the RARC pentafecta had significantly better survival outcomes compared with those who did not. These criteria could be used to standardize assessment of the surgical quality of RARC. In the future, a similar study using an independent cohort is warranted to confirm our results.

Multicenter external validation of the radical cystectomy pentafecta in a European cohort of patients undergoing robot-assisted radical cystectomy with intracorporeal urinary diversion for bladder cancer

“…A recent multicenter study try to validate the Cacciamani 's RC-pentafecta [29] The authors performed a multicentric external validation of the RC-pentafecta. Among the 730 patients included 208 (28.5%) acheieved the RC-pentafecta.…”

“…The collected perioperative variables included the type of urinary diversion, operating time (min), estimated blood loss (EBL) (quantified by the sum of suction device and pads) and perioperative transfusions. The postoperative data included: complications within 90 days according to the Clavien-Dindo (CD) classification [9] by separating minor (CD ≤ II) and major (CD ≥ III) postoperative complications, urinary diversion (UD)-related sequelae as previously reported [10] within 12 months, length of hospital stay (LOS), and the 90 days readmission rate. UD-related sequelae complications were defined by all urinary events within 12 months after surgery, and included urinary fistulas, uretero-ileal anastomotic strictures, stoma hernias, and stones [10,11].…”

“…To be considered a validated pentafecta, patients had to meet all of the following five criteria: removal of ≥ 16 lymph nodes, negative soft tissue surgical margins, absence of major complications (CD ≥ III) within 90 days, absence of UD-related sequelae within 12 months as previously defined [10] and absence of local or distant recurrence within 12 months.…”

Re: Oncological outcome according to attainment of pentafecta after robot‐assisted radical cystectomy in patients with bladder cancer in the multicentre KORARC database. BJU Int 2020 July 18. DOI: 10.1111/ bju.15178

“…We have read with great interest the paper “Oncological outcome according to attainment of pentafecta after robot‐assisted radical cystectomy in patients with bladder cancer included in the multicentre KORARC database” by Oh et al . [1]. The authors performed a multicentric external validation of the radical cystectomy (RC) pentafecta [2].…”

“…In their multicentre validation, Oh et al . [1] considered only uretero‐enteric strictures in lieu of the broader component of all UD‐related events, arguing that ‘several events overlapped with postoperative complications factors within 90 days and stoma‐related complications were shown to only minimally influence survival outcomes’. This statement is not accurate as we defined UD‐sequelae as every adverse event after 90 days that is directly linked to the UD [2], which could cause UD malfunction in the long term, impacting inevitably on patient quality of life [6].…”