Port-site metastasis and atypical recurrences after robotic-assisted radical cystectomy (RARC): an updated comprehensive and systematic review of current evidences

Mantica, Guglielmo; Smelzo, Salvatore; Ambrosini, Francesca; Tappero, Stefano; Parodi, Stefano; Pacchetti, Andrea; Marchi, Davide De; Gaboardi, Franco; Suardi, Nazareno; Terrone, Carlo

doi:10.1007/s11701-020-01062-x

Cited by 20 publications

(15 citation statements)

References 61 publications

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“…Recently, the risk for atypical metastases has proven to be low in several studies, including the 5‐ and 10‐years oncological outcomes of the IRCC which also comprised many of our RARC 12,26 . Of great importance, the oncological outcomes are comparable to ORC irrespective of the urinary diversion, including orthotopic intracorporeal neobladders 3,11,12,18,27 . For this reason, we have broadened our indication for RARC again.…”

Section: Discussionmentioning

confidence: 99%

“…Another factor contributing to the deferred transition from the open to the robotic approach were reports on atypical metastases after RARC, which peaked in 2016 8–10 . The reasons for this phenomenon have not yet been fully understood, but meta‐analyses recently indicated that the risk for atypical metastases is low after RARC and decreases with growing surgical expertise 11–14 …”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Robot‐assisted versus open radical cystectomy: A cohort study on perioperative outcomes accounting for stage selection bias and surgical experience

Zeuschner

Linxweiler

Mohr

et al. 2021

Robotics Computer Surgery

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Background Most comparisons of robot‐assisted (RARC) versus open radical cystectomy (ORC) for urothelial carcinoma do not factor the inherent stage selection bias or surgical experience. Methods We compared the perioperative outcomes of 229 RARC and 335 ORC at a single tertiary referral centre with propensity score matching and multiple regression models, when controlling for tumour and patient characteristics, surgeon's experience and type of urinary diversion. Results RARC had less major complications (19.8% vs. 34.1%) and ICU admissions (6.6% vs. 19.8%), with lower blood loss (400 vs. 500 ml) and transfusion rates. The operating time was longer (336 vs. 286 min), but decreased with surgeon's experience. RARC had less positive surgical margins (3% vs. 8.4%) and a higher lymph node count (14 vs. 11). Conclusions In this large single centre series comparing RARC with ORC controlling for stage selection bias and surgical experience, RARC proved significantly better outcomes, especially with intracorporeal urinary diversion.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Robot‐assisted versus open radical cystectomy: A cohort study on perioperative outcomes accounting for stage selection bias and surgical experience

Zeuschner

Linxweiler

Mohr

et al. 2021

Robotics Computer Surgery

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“…A recent systematic review reported 105 (1.63%) atypical metastases in 6720 patients whose underwent RARC. 8 The most common atypical recurrence was peritoneal carcinomatosis (60% of patients). Other sites were extrapelvic lymph nodes, port-site and retroperitoneum.…”

Section: Discussionmentioning

confidence: 99%

Massive intra-abdominal recurrence after robotic-assisted radical cystectomy: A case report and critical appraisal of literature

et al. 2020

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Introduction: Over the years, the robotic surgery is gaining increasing importance in the treatment of bladder cancer. Some doubts remain about the oncological safety of robotic approach and alerts have been raised about the occurrence of atypical recurrences, including peritoneal carcinomatosis and port-site metastasis. Case presentation: The patient referred to our Emergency Department because of acute confusional state probably due to severe anemia and sepsis. A left nephroureterectomy, left hemicolectomy with end colostomy and the surgical excision of the huge mass was performed through a xipho-pubic incision associated to another left peri-stomal incision. The histological specimen analysis showed a high-grade sarcoma, not otherwise specified (sarcoma, NOS-type), measuring 29 cm × 8 cm × 5 cm in diameters. The left kidney and ureter were not infiltrated by the neoplasm while serosa membranes and muscular layers of left colon were infiltrated by the mass. The patient died because of a cardiac arrest 4 days after surgery. Discussion: RARC is a safe and feasible alternative to open radical cystectomy (ORC) with satisfactory operative time, little blood loss, and low transfusion rates. Despite this, RARC is associated with a low, but not neglectable, risk of atypical metastases like peritoneal implants and port-site metastasis. Although a small amount (7%) of RARC were performed in non-urothelial variants of bladder cancer, the sarcomatoid one can be related to a greater risk of atypical recurrence and special precaution should be taken to reduce potential causes of tumor seeding.

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“…1 Furthermore, there have been several reports of disseminated recurrences, such as port-site recurrence and abdominal recurrences, after MIRC. 2 In this study, Huang et al reported outcomes comparing 195 patients with LRC and 412 patients with open radical cystectomy. 3 Regarding the perioperative data, LRC showed significantly less blood loss.…”

Section: Supporting Informationmentioning

confidence: 93%

“…Recently, newer publications on RARC have also become available, including a randomized controlled trial that showed no increase in tumor dissemination after RARC. 2 Unfortunately, several studies showed certain selection biases with younger age and earlier disease stage in the LRC groups, perhaps due to limited sample size. 3,4 Hence, the oncological outcome associated with a minimally invasive approach to urothelial carcinoma remains unclear.…”

Section: Editorial Commentmentioning

confidence: 99%

Editorial Comment from Dr Kanno to Laparoscopic versus open radical cystectomy in 607 patients with bladder cancer: Comparative survival analysis

Kanno

2021

Int J of Urology

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Port-site metastasis and atypical recurrences after robotic-assisted radical cystectomy (RARC): an updated comprehensive and systematic review of current evidences

Cited by 20 publications

References 61 publications

Robot‐assisted versus open radical cystectomy: A cohort study on perioperative outcomes accounting for stage selection bias and surgical experience

Robot‐assisted versus open radical cystectomy: A cohort study on perioperative outcomes accounting for stage selection bias and surgical experience

Massive intra-abdominal recurrence after robotic-assisted radical cystectomy: A case report and critical appraisal of literature

Editorial Comment from Dr Kanno to Laparoscopic versus open radical cystectomy in 607 patients with bladder cancer: Comparative survival analysis

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