Presentation Authors: Jim Shen*, Patrick Kilday, Avinash Chenam, Juzar Jamnagerwalla, Nora Ruel, Clayton Lau, Bertram Yuh, Duarte, CA
Introduction: Concern has been raised about the oncologic soundness of robot-assisted radical cystectomy (RARC). We present our experience with disease recurrence and metastasis after RARC for bladder cancer.
Methods: The City of Hope RARC database was queried to identify all patients who underwent RARC for primary urothelial carcinoma of the bladder between 2003 and 2015. Disease recurrences and metastases were categorized by location. The reverse Kaplan-Meier method was used to calculate time to recurrence- or metastasis-free (RMFS) and overall survival (OS). Log rank test was used to compare survival curves. Univariate and multivariate analysis were performed to identify predictors of RMFS and OS.
Results: 379 patients fit the study criteria. The median follow up was 61 months. 97 patients (25.6%) developed recurrence or metastasis during the study period. The most common site of recurrence or metastasis was the pelvis (n=33), followed by the lungs (n=24), retroperitoneum (n=23), bone (n=19), and liver (n=13). The most distant extent of disease in these patients was locoregional recurrence in 20 patients, retroperitoneal recurrence in 13 patients, distant metastasis in 54 patients, and peritoneal carcinomatosis in 10 patients. 11 of 379 (2.9%) patients had positive surgical margins. 12.4% of patients who did not develop recurrence or metastasis were node-positive (35/282), compared to 44.3% (43/97) of patients who did develop recurrence or metastasis. 3 year RMFS for
Conclusions: RARC demonstrates acceptable RMFS and OS across disease stages. Pathologic T stage and pN+ disease predict RMFS and OS after RARC. ASA also predicts OS after RARC.