Presentation Authors: Aldo Brassetti*, Gabriele Tuderti, Salvatore Guaglianone, Maria Consiglia Ferriero, Umberto Anceschi, Francesco Minisola, Riccardo Mastroianni, Rocco Simone Flammia, Michele Gallucci, Giuseppe Simone, Rome, Italy
Introduction: Robot-assisted radical cystectomy (RARC) with orthotopic neobladder (ON) is associated with heterogeneous surgical, functional and oncological outcomes. These are currently presented separately, while the success of this surgery depends on a combination of good cancer control, no surgery-related complications and urinary continence. We propose a combination of three standardized and reproducible postoperative criteria (Trifecta) to optimize outcomes reporting after RARC with ON.
Methods: our prospectively maintained database of patients undergoing RARC with intracorporeal ON for bladder cancer (BC) was queried for baseline demographics, clinical, pathologic and peri-/post-operative data. We defined the â€œtrifectaâ€ as the combination of daily urinary continence, no reoperations (meaning neither post-operative complications Clavien-Dindo â‰¥ 3 nor other surgical interventions related to RARC/ON, after discharge) and recurrence-free status, all assessed at one year. Kaplan-Meier analysis was performed to assess the predictive role of trifecta outcomes on overall survival. Univariable and multivariable logistic regression analyses were performed to identify predictors of trifecta achievement.
Results: Overall, 137 patients were included in the analysis (Table 1); 72 (53%) achieved the trifecta (Figure 1). On Kaplan-Meier analysis, it was significantly associated with a better overall survival (OS) (Log Rank = 0.032). On univariable analysis, age, body mass index, neoadjuvant chemotherapy and pathological stage predicted trifecta; on multivariable regression, this association was only confirmed for age and stage (Table 2).
Conclusions: Our trifecta is the first standardized and reproducible system specifically designed to provide a comprehensive summary of global results after RARC with ON. Although external validation studies are required, this novel tool may optimize outcomes reporting and facilitate comparisons between various surgical technique.