Outcomes of robotic‐assisted versus open radical cystectomy in a large‐scale, contemporary cohort of bladder cancer patients

Hoeh, Benedikt; Flammia, Rocco Simone; Hohenhorst, Lukas; Sorce, Gabriele; Chierigo, Francesco; Panunzio, Andrea; Tian, Zhe; Saad, Fred; Gallucci, Michele; Briganti, Alberto; Terrone, Carlo; Shariat, Shahrokh F.; Graefen, Markus; Tilki, Derya; Antonelli, Alessandro; Kluth, Luis A.; Becker, Andreas; Chun, Felix K.‐H.; Karakiewicz, Pierre I.

doi:10.1002/jso.26973

Cited by 8 publications

(4 citation statements)

References 31 publications

(103 reference statements)

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“…independently from age, 29 we provided evidence that open RC is still the most exploited surgical approach for RC in octogenarians.…”

Section: Discussionmentioning

confidence: 78%

“…In 2009, Frohener et al 26 recognized as reason of lower access to minimally invasive RC for elderly patients, the high challenging profile of the procedure, less likely therefore, to be offered to frail and older patients, at least during the learning curve. Despite minimally invasive RC has been proved to be non‐inferior to open RC in terms of progression‐free survival, 27 as well as to be able to yield LOS benefit in elderly patients, 28 and perioperative morbidity benefit independently from age, 29 we provided evidence that open RC is still the most exploited surgical approach for RC in octogenarians.…”

Section: Discussionmentioning

confidence: 84%

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Age represents the main driver of surgical decision making in patients candidate to radical cystectomy

Dell’Oglio

Tappero

Panunzio

et al. 2023

Journal of Surgical Oncology

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Background and Objectives Age might influence the choice of surgical approach, type of urinary diversion (UD) and lymph node dissection (LND) in patients candidate to radical cystectomy (RC) for urothelial bladder cancer (UBC). Similarly, age may enhance surgical morbidity and worsen perioperative outcomes. We tested the impact of age (octogenarian vs. younger patients) on surgical decision making and peri‐ and postoperative outcomes of RC. Methods Non‐metastatic muscle‐invasive UBC patients treated with RC at 18 high‐volume European institutions between 2006 and 2021 were identified and stratified according to age (≥80 vs. <80 years). Intraoperative Complications Assessment and Reporting with Universal Standards and European Association of Urology guidelines recommendations were accomplished in collection and reporting of, respectively, intraoperative and postoperative complications. Multivariable logistic regression models (MVA) tested the impact of age on outcomes of interest. Sensitivity analyses after 1:3 propensity score matching were performed. Results Of 1955 overall patients, 251 (13%) were ≥80‐year‐old. Minimally invasive RC was performed in 18% and 40% of octogenarian and younger patients, respectively (p < 0.001). UD without bowel manipulation (ureterocutaneostomy, UCS) was performed in 31% and 7% of octogenarian and younger patients (p < 0.001). LND was delivered to 81% and 93% of octogenarian and younger patients (p < 0.001). At MVA, age ≥80 years independently predicted open approach (odds ratio [OR]: 1.55), UCS (OR: 3.70), and omission of LND (OR: 0.41; all p ≤ 0.02). Compared to their younger counterparts, octogenarian patients experienced higher rates of intraoperative (8% vs. 4%, p = 0.04) but not of postoperative complications (64% vs. 61%, p = 0.07). At MVA, age ≥80 years was not an independent predictor of length of stay, intraoperative or postoperative transfusions and complications, and readmissions (all p values >0.1). These results were replicated in sensitivity analyses. Conclusions Age ≥80 years does not independently portend worse surgical outcomes for RC. However, octogenarians are unreasonably more likely to receive open approach and UCS diversion, and less likely to undergo LND.

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“…independently from age, 29 we provided evidence that open RC is still the most exploited surgical approach for RC in octogenarians.…”

Section: Discussionmentioning

confidence: 78%

Section: Discussionmentioning

confidence: 84%

Age represents the main driver of surgical decision making in patients candidate to radical cystectomy

Dell’Oglio

Tappero

Panunzio

et al. 2023

Journal of Surgical Oncology

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“…Third, within the current study, solely perioperative outcomes were investigated in RAPN vs OPN. It is of note that the current study did not perform cost-analyses, and therefore, cost-effectiveness conclusions regarding surgical approach (robotic-assisted vs open) cannot be drawn from the current manuscript as previously performed for urological cancer surgeries [ 32 – 34 ]. Fourth and finally, limitations that are inherent due to the retrospective nature of the study might be present, and thus, results must be interpreted accordingly.…”

Section: Discussionmentioning

confidence: 99%

Comparison of peri- and intraoperative outcomes of open vs robotic-assisted partial nephrectomy for renal cell carcinoma: a propensity-matched analysis

et al. 2023

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Background Partial nephrectomy (PN) is the gold standard surgical treatment for resectable renal cell carcinoma (RCC) tumors. However, the decision whether a robotic (RAPN) or open PN (OPN) approach is chosen is often based on the surgeon’s individual experience and preference. To overcome the inherent selection bias when comparing peri- and postoperative outcomes of RAPN vs. OPN, a strict statistical methodology is needed. Materials and methods We relied on an institutional tertiary-care database to identify RCC patients treated with RAPN and OPN between January 2003 and January 2021. Study endpoints were estimated blood loss (EBL), length of stay (LOS), rate of intraoperative and postoperative complications, and trifecta. In the first step of analyses, descriptive statistics and multivariable regression models (MVA) were applied. In the second step of analyses, to validate initial findings, MVA were applied after 2:1 propensity-score matching (PSM). Results Of 615 RCC patients, 481 (78%) underwent OPN vs 134 (22%) RAPN. RAPN patients were younger and presented with a smaller tumor diameter and lower RENAL-Score sum, respectively. Median EBL was comparable, whereas LOS was shorter in RAPN vs. OPN. Both intraoperative (27 vs 6%) and Clavien-Dindo > 2 complications (11 vs 3%) were higher in OPN (both < 0.05), whereas achievement of trifecta was higher in RAPN (65 vs 54%; p = 0.028). In MVA, RAPN was a significant predictor for shorter LOS, lower rates of intraoperative and postoperative complications as well as higher trifecta rates. After 2:1 PSM with subsequent MVA, RAPN remained a statistical and clinical predictor for lower rates of intraoperative and postoperative complications and higher rates of trifecta achievement but not LOS. Conclusions Differences in baseline and outcome characteristics exist between RAPN vs. OPN, probably due to selection bias. However, after applying two sets of statistical analyses, RAPN seems to be associated with more favorable outcomes regarding complications and trifecta rates.

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“…RC is still considered a complex surgery associated with higher morbidity [5,15]. Indeed, the scientific community has predominantly focused its efforts on survival outcomes and perioperative complications, which are always considered the major goals in any genitourinary cancer treatment [16,17]. Moreover, since the widespread diffusion of minimally invasive surgery, a comparison between different surgical approaches has been considered of primary importance [18].…”

Section: Discussionmentioning

confidence: 99%

Health Related Quality of Life in Patients with Bladder Cancer Receiving a Radical Cystectomy

Mastroianni,

Iannuzzi,

Ragusa

et al. 2023

Cancers

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Radical Cystectomy (RC) and Urinary Diversion (UD) is a complex surgery associated with a significant impact on health-related quality of life (HRQoL). However, HRQoL assessment is too often overlooked, with survival and complications being the most commonly investigated outcomes. This study aimed to identify the most impaired HRQoL features in patients receiving RC, compared to a healthy population (HP) control, as well as patients’ recovery after surgery, differentiating between patients receiving ORC and RARC. Patients with Bca, who were candidates for RC with curative intent, were enrolled in the “BCa cohort”. HRQoL outcomes were collected with an EORTC QLQ-C30 questionnaire. These were collected at baseline, and then at 6-, 12- and 24 mo after surgery in the BCa cohorts, and at baseline in the HP cohort. A 1:1 propensity score matched (PSM)-analysis, adjusted for age, Charlson Comorbidity Index (CCI) and smoking history, was performed. Between January 2018 and February 2023, a total of 418 patients were enrolled in the study, 116 and 302 in the BCa and HP cohorts, respectively. After applying the 1:1 propensity scored match (PSM) analysis, two homogeneous cohorts were selected, including 85 patients in each group. Baseline HRQoL assessment showed a significant impairment in terms of emotional and cognitive functioning, appetite loss and financial difficulties for the BCa cohort. Among secondary outcomes, we investigated patients’ recovery after RC and UD, comparing HRQoL outcome questionnaires between the HP and BCa cohorts at 6-, 12- and 24 mo after surgery, and a subgroup analysis was performed differentiating between patients receiving ORC and RARC with totally intracorporeal UD. Interestingly, ORC compared to RARC provided a major impact on HRQoL recovery across the early, mid and long term. In particular, the ORC cohort experienced a major impairment in terms of symptoms scales items such as fatigue, nausea and vomiting, pain and appetite loss. Consequently, comparing ORC and RARC vs. HP reported a major HRQoL impairment in the ORC cohort, possibly defining a benefit of RARC in early, mid- and long-term recovery. To conclude, this study confirmed the undeniable impact of RC on HRQoL. Interestingly, we highlighted the benefit of RARC in early, mid- and long-term recovery, expressed as less impairment of symptoms scales.

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Outcomes of robotic‐assisted versus open radical cystectomy in a large‐scale, contemporary cohort of bladder cancer patients

Cited by 8 publications

References 31 publications

Age represents the main driver of surgical decision making in patients candidate to radical cystectomy

Age represents the main driver of surgical decision making in patients candidate to radical cystectomy

Comparison of peri- and intraoperative outcomes of open vs robotic-assisted partial nephrectomy for renal cell carcinoma: a propensity-matched analysis

Health Related Quality of Life in Patients with Bladder Cancer Receiving a Radical Cystectomy

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