Robot Assisted Radical Cystectomy vs Open Radical Cystectomy: Over 10 years of the Mayo Clinic Experience

Kassem S. Faraj, Haidar M. Abdul-Muhsin, Kyle M. Rose, Anojan K. Navaratnam, Michael W. Patton, Sarah Eversman, Rohan Singh, William G. Eversman, Scott M. Cheney, Mark D. Tyson, Erik P Castle

Research output: Contribution to journalArticle

Abstract

Objectives: There is scant information about intermediate / long-term comparative outcomes between robot assisted radical cystectomy (RARC) and open radical cystectomy (ORC). The purpose of this study is to present survival and oncological outcomes between bladder cancer patients who undergo RARC vs. ORC with an overall median follow-up of over 5 years. Materials and Methods: A query of all patients who underwent radical cystectomy between January, 2007 and January, 2018 at Mayo Clinic Arizona yielded 595 patients. After excluding cystectomy performed for nonmalignant indication, cancer secondary to nonbladder primary, and cancers with grossly metastatic disease at the time of surgery, 481 patients remained. Data was collected on patient demographics, preoperative information, operative details, complications, and follow-up. Statistical analyses were generated using SPSS 22.0. Results: In 481 total patients, 203 (42.2%) underwent RARC and 278 (57.8%) underwent ORC. The median follow-up for the entire cohort was 66 months. The 5-year recurrence-free survival (RFS) was 70.8% vs. 64.7% and the 10-year RFS was 69.6% vs. 62.7% for the RARC vs. ORC, respectively (P = 0.135). The 5-year overall survival (OS) was 58.9% vs. 57.7% and the 10-year OS was 39.9% vs. 45.6% for RARC vs. ORC patients, respectively (P = 0.466). There were no differences in any recurrence patterns, including the incidence of atypical recurrences (1.5% vs. 1.8% [P = 0.786], respectively). A Cox-proportional hazards model was fitted that included independent predictors of RFS and OS. The results revealed no difference in RFS (HR 1.235, 95% CI: 0.832–1.833, P = 0.295) or OS (HR 0.790, 95% CI: 0.550–1.135, P = 0.202) between the respectively. Conclusions: Recurrence free survival, OS, and recurrence patterns are similar in bladder cancer patients who undergo either RARC or ORC.

Original languageEnglish (US)
JournalUrologic Oncology: Seminars and Original Investigations
DOIs
StateAccepted/In press - Jan 1 2019

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Cystectomy
Survival
Recurrence
Urinary Bladder Neoplasms
Proportional Hazards Models
Neoplasms

Keywords

  • Bladder cancer
  • Cystectomy
  • Lymph node dissection
  • Robot assisted
  • Robotics

ASJC Scopus subject areas

  • Oncology
  • Urology

Cite this

Robot Assisted Radical Cystectomy vs Open Radical Cystectomy : Over 10 years of the Mayo Clinic Experience. / Faraj, Kassem S.; Abdul-Muhsin, Haidar M.; Rose, Kyle M.; Navaratnam, Anojan K.; Patton, Michael W.; Eversman, Sarah; Singh, Rohan; Eversman, William G.; Cheney, Scott M.; Tyson, Mark D.; Castle, Erik P.

In: Urologic Oncology: Seminars and Original Investigations, 01.01.2019.

Research output: Contribution to journalArticle

Faraj, Kassem S. ; Abdul-Muhsin, Haidar M. ; Rose, Kyle M. ; Navaratnam, Anojan K. ; Patton, Michael W. ; Eversman, Sarah ; Singh, Rohan ; Eversman, William G. ; Cheney, Scott M. ; Tyson, Mark D. ; Castle, Erik P. / Robot Assisted Radical Cystectomy vs Open Radical Cystectomy : Over 10 years of the Mayo Clinic Experience. In: Urologic Oncology: Seminars and Original Investigations. 2019.
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abstract = "Objectives: There is scant information about intermediate / long-term comparative outcomes between robot assisted radical cystectomy (RARC) and open radical cystectomy (ORC). The purpose of this study is to present survival and oncological outcomes between bladder cancer patients who undergo RARC vs. ORC with an overall median follow-up of over 5 years. Materials and Methods: A query of all patients who underwent radical cystectomy between January, 2007 and January, 2018 at Mayo Clinic Arizona yielded 595 patients. After excluding cystectomy performed for nonmalignant indication, cancer secondary to nonbladder primary, and cancers with grossly metastatic disease at the time of surgery, 481 patients remained. Data was collected on patient demographics, preoperative information, operative details, complications, and follow-up. Statistical analyses were generated using SPSS 22.0. Results: In 481 total patients, 203 (42.2{\%}) underwent RARC and 278 (57.8{\%}) underwent ORC. The median follow-up for the entire cohort was 66 months. The 5-year recurrence-free survival (RFS) was 70.8{\%} vs. 64.7{\%} and the 10-year RFS was 69.6{\%} vs. 62.7{\%} for the RARC vs. ORC, respectively (P = 0.135). The 5-year overall survival (OS) was 58.9{\%} vs. 57.7{\%} and the 10-year OS was 39.9{\%} vs. 45.6{\%} for RARC vs. ORC patients, respectively (P = 0.466). There were no differences in any recurrence patterns, including the incidence of atypical recurrences (1.5{\%} vs. 1.8{\%} [P = 0.786], respectively). A Cox-proportional hazards model was fitted that included independent predictors of RFS and OS. The results revealed no difference in RFS (HR 1.235, 95{\%} CI: 0.832–1.833, P = 0.295) or OS (HR 0.790, 95{\%} CI: 0.550–1.135, P = 0.202) between the respectively. Conclusions: Recurrence free survival, OS, and recurrence patterns are similar in bladder cancer patients who undergo either RARC or ORC.",
keywords = "Bladder cancer, Cystectomy, Lymph node dissection, Robot assisted, Robotics",
author = "Faraj, {Kassem S.} and Abdul-Muhsin, {Haidar M.} and Rose, {Kyle M.} and Navaratnam, {Anojan K.} and Patton, {Michael W.} and Sarah Eversman and Rohan Singh and Eversman, {William G.} and Cheney, {Scott M.} and Tyson, {Mark D.} and Castle, {Erik P}",
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T2 - Over 10 years of the Mayo Clinic Experience

AU - Faraj, Kassem S.

AU - Abdul-Muhsin, Haidar M.

AU - Rose, Kyle M.

AU - Navaratnam, Anojan K.

AU - Patton, Michael W.

AU - Eversman, Sarah

AU - Singh, Rohan

AU - Eversman, William G.

AU - Cheney, Scott M.

AU - Tyson, Mark D.

AU - Castle, Erik P

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives: There is scant information about intermediate / long-term comparative outcomes between robot assisted radical cystectomy (RARC) and open radical cystectomy (ORC). The purpose of this study is to present survival and oncological outcomes between bladder cancer patients who undergo RARC vs. ORC with an overall median follow-up of over 5 years. Materials and Methods: A query of all patients who underwent radical cystectomy between January, 2007 and January, 2018 at Mayo Clinic Arizona yielded 595 patients. After excluding cystectomy performed for nonmalignant indication, cancer secondary to nonbladder primary, and cancers with grossly metastatic disease at the time of surgery, 481 patients remained. Data was collected on patient demographics, preoperative information, operative details, complications, and follow-up. Statistical analyses were generated using SPSS 22.0. Results: In 481 total patients, 203 (42.2%) underwent RARC and 278 (57.8%) underwent ORC. The median follow-up for the entire cohort was 66 months. The 5-year recurrence-free survival (RFS) was 70.8% vs. 64.7% and the 10-year RFS was 69.6% vs. 62.7% for the RARC vs. ORC, respectively (P = 0.135). The 5-year overall survival (OS) was 58.9% vs. 57.7% and the 10-year OS was 39.9% vs. 45.6% for RARC vs. ORC patients, respectively (P = 0.466). There were no differences in any recurrence patterns, including the incidence of atypical recurrences (1.5% vs. 1.8% [P = 0.786], respectively). A Cox-proportional hazards model was fitted that included independent predictors of RFS and OS. The results revealed no difference in RFS (HR 1.235, 95% CI: 0.832–1.833, P = 0.295) or OS (HR 0.790, 95% CI: 0.550–1.135, P = 0.202) between the respectively. Conclusions: Recurrence free survival, OS, and recurrence patterns are similar in bladder cancer patients who undergo either RARC or ORC.

AB - Objectives: There is scant information about intermediate / long-term comparative outcomes between robot assisted radical cystectomy (RARC) and open radical cystectomy (ORC). The purpose of this study is to present survival and oncological outcomes between bladder cancer patients who undergo RARC vs. ORC with an overall median follow-up of over 5 years. Materials and Methods: A query of all patients who underwent radical cystectomy between January, 2007 and January, 2018 at Mayo Clinic Arizona yielded 595 patients. After excluding cystectomy performed for nonmalignant indication, cancer secondary to nonbladder primary, and cancers with grossly metastatic disease at the time of surgery, 481 patients remained. Data was collected on patient demographics, preoperative information, operative details, complications, and follow-up. Statistical analyses were generated using SPSS 22.0. Results: In 481 total patients, 203 (42.2%) underwent RARC and 278 (57.8%) underwent ORC. The median follow-up for the entire cohort was 66 months. The 5-year recurrence-free survival (RFS) was 70.8% vs. 64.7% and the 10-year RFS was 69.6% vs. 62.7% for the RARC vs. ORC, respectively (P = 0.135). The 5-year overall survival (OS) was 58.9% vs. 57.7% and the 10-year OS was 39.9% vs. 45.6% for RARC vs. ORC patients, respectively (P = 0.466). There were no differences in any recurrence patterns, including the incidence of atypical recurrences (1.5% vs. 1.8% [P = 0.786], respectively). A Cox-proportional hazards model was fitted that included independent predictors of RFS and OS. The results revealed no difference in RFS (HR 1.235, 95% CI: 0.832–1.833, P = 0.295) or OS (HR 0.790, 95% CI: 0.550–1.135, P = 0.202) between the respectively. Conclusions: Recurrence free survival, OS, and recurrence patterns are similar in bladder cancer patients who undergo either RARC or ORC.

KW - Bladder cancer

KW - Cystectomy

KW - Lymph node dissection

KW - Robot assisted

KW - Robotics

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