The Role of Robotic Cystectomy in the Salvage and Palliative Setting: A Retrospective, Single-Center, Cohort Study

Overview

Journal Cancers (Basel)

Publisher MDPI

Specialty Oncology

Date 2024 Nov 27

PMID 39594739

Authors

Aldo Brassetti

Loris Cacciatore

Flavia Proietti

Rigoberto Pallares-Mendez

Alfredo Maria Bove

Umberto Anceschi

Riccardo Mastroianni

Leonardo Misuraca

Gabriele Tuderti

Giuseppe Chiacchio

Mariaconsiglia Ferriero

Rocco Simone Flammia

Costantino Leonardo

Giuseppe Simone

Affiliations

Soon will be listed here.

Abstract

This article compares surgical and survival outcomes of robot-assisted and open radical cystectomy with cutaneous ureterostomy for the treatment of frail bladder cancer patients with limited life expectancy. The institutional database was searched for cystectomy cases with cutaneous ureterostomy, from 1 June 2016 to 31 August 2022. The study population was split into two groups, according to the surgical approach. The baseline characteristics and surgical outcomes were compared. Logistic regression analyses identified predictors of major bleeding events (hemoglobin loss ≥ 3.5 g/dL or blood transfusion) and re-operation within 30 days from surgery. The Kaplan-Meier method estimated the impact of the robotic approach on overall survival and Cox regression analysis assessed its predictors. A total of 145 patients were included: 30% (n = 43) underwent robotic cystectomy. Patients' characteristics and tumor stages distribution were comparable in the two groups but those receiving a minimally invasive treatment showed significantly reduced times to flatus, bowel and hospital discharge (all < 0.001). Although operation times were longer in this cohort, major bleeding events (60% vs. 89%) and postoperative severe complications (0 vs. 8%) (both < 0.001) were less frequent compared to the open approach. A logistic regression showed that robotic surgery independently predicted major bleeding events (OR: 0.26; 95%CI 0.09-0.72; = 0.02) but not the need for re-intervention. A Kaplan-Meier analysis showed that robotic cystectomy was associated with a significant advantage in terms of overall survival (LogRank = 0.03), and this result was confirmed by Cox regression analysis (HR: 0.39; 95%CI 0.14-0.94; = 0.04). Robotic cystectomy with cutaneous ureterostomy may represent a viable option to treat frail bladder cancer patients, as the minimally invasive approach reduces the risk of bleeding and serious complications and provides a prompt restoration of bowel function and a shorter hospital stay compared to open surgery.

References

Deliveliotis C, Papatsoris A, Chrisofos M, Dellis A, Liakouras C, Skolarikos A . Urinary diversion in high-risk elderly patients: modified cutaneous ureterostomy or ileal conduit?. Urology. 2005; 66(2):299-304. DOI: 10.1016/j.urology.2005.03.031. View

Fonteyne V, Rammant E, Ost P, Lievens Y, De Troyer B, Rottey S . Evaluating the Current Place of Radiotherapy as Treatment Option for Patients With Muscle Invasive Bladder Cancer in Belgium. Clin Genitourin Cancer. 2018; 16(6):e1159-e1169. DOI: 10.1016/j.clgc.2018.07.026. View

Bochner B, Dalbagni G, Sjoberg D, Silberstein J, Paz G, Donat S . Comparing Open Radical Cystectomy and Robot-assisted Laparoscopic Radical Cystectomy: A Randomized Clinical Trial. Eur Urol. 2014; 67(6):1042-1050. PMC: 4424172. DOI: 10.1016/j.eururo.2014.11.043. View

Mally D, John P, Pfister D, Heidenreich A, Albers P, Niegisch G . Comparative Analysis of Elderly Patients Undergoing Radical Cystectomy With Ureterocutaneostomy or Ileal Conduit With a Special Focus on Bowl Complications Requiring Surgical Revision. Front Surg. 2022; 9:803926. PMC: 9226401. DOI: 10.3389/fsurg.2022.803926. View

Yong C, Daihui C, Bo Z . Laparoscopic versus open radical cystectomy for patients with bladder cancer over 75-year-old: a prospective randomized controlled trial. Oncotarget. 2017; 8(16):26565-26572. PMC: 5432279. DOI: 10.18632/oncotarget.15717. View

Large M, Reichard C, Williams J, Chang C, Prasad S, Leung Y . Incidence, risk factors, and complications of postoperative delirium in elderly patients undergoing radical cystectomy. Urology. 2012; 81(1):123-8. DOI: 10.1016/j.urology.2012.07.086. View

Bochner B, Dalbagni G, Marzouk K, Sjoberg D, Lee J, Donat S . Randomized Trial Comparing Open Radical Cystectomy and Robot-assisted Laparoscopic Radical Cystectomy: Oncologic Outcomes. Eur Urol. 2018; 74(4):465-471. PMC: 6697266. DOI: 10.1016/j.eururo.2018.04.030. View

Burger M, Catto J, Dalbagni G, Grossman H, Herr H, Karakiewicz P . Epidemiology and risk factors of urothelial bladder cancer. Eur Urol. 2012; 63(2):234-41. DOI: 10.1016/j.eururo.2012.07.033. View

Brassetti A, Moller A, Laurin O, Hoijer J, Adding C, Miyakawa A . Evolution of cystectomy care over an 11-year period in a high-volume tertiary referral centre. BJU Int. 2017; 121(5):752-757. DOI: 10.1111/bju.14112. View

10.

Clavien P, Barkun J, De Oliveira M, Vauthey J, Dindo D, Schulick R . The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009; 250(2):187-96. DOI: 10.1097/SLA.0b013e3181b13ca2. View

11.

Simone G, Papalia R, Misuraca L, Tuderti G, Minisola F, Ferriero M . Robotic Intracorporeal Padua Ileal Bladder: Surgical Technique, Perioperative, Oncologic and Functional Outcomes. Eur Urol. 2016; 73(6):934-940. DOI: 10.1016/j.eururo.2016.10.018. View

12.

Kristo A, Klimis-Zacas D, Sikalidis A . Protective Role of Dietary Berries in Cancer. Antioxidants (Basel). 2016; 5(4). PMC: 5187535. DOI: 10.3390/antiox5040037. View

13.

Hollenbeck B, Miller D, Taub D, Dunn R, Underwood 3rd W, Montie J . Aggressive treatment for bladder cancer is associated with improved overall survival among patients 80 years old or older. Urology. 2004; 64(2):292-7. DOI: 10.1016/j.urology.2004.03.034. View

14.

Sathianathen N, Jarosek S, Lawrentschuk N, Bolton D, Konety B . A Simplified Frailty Index to Predict Outcomes After Radical Cystectomy. Eur Urol Focus. 2018; 5(4):658-663. DOI: 10.1016/j.euf.2017.12.011. View

15.

Brassetti A, Cacciamani G, Anceschi U, Ferriero M, Tuderti G, Miranda G . Long-term oncologic outcomes of robot-assisted radical cystectomy (RARC) with totally intracorporeal urinary diversion (ICUD): a multi-center study. World J Urol. 2019; 38(4):837-843. DOI: 10.1007/s00345-019-02842-3. View

16.

Serretta V, Di Maida F, Baiamonte D, Vella M, Pavone C, Cacciatore L . Does Smoking Cessation at Primary Diagnosis Reduce the Recurrence Risk of Nonmuscle-Invasive Bladder Cancer? Results of a Prospective Study. Urol Int. 2020; 104(5-6):396-401. DOI: 10.1159/000507122. View

17.

Fuschi A, Al Salhi Y, Sequi M, Velotti G, Martoccia A, Suraci P . Evaluation of Functional Outcomes and Quality of Life in Elderly Patients (>75 y.o.) Undergoing Minimally Invasive Radical Cystectomy with Single Stoma Ureterocutaneostomy vs. Bricker Intracorporeal Ileal Conduit Urinary Diversion. J Clin Med. 2022; 11(1). PMC: 8745776. DOI: 10.3390/jcm11010136. View

18.

Haden T, Prunty M, Jones A, Deroche C, Murray K, Pokala N . Comparative Perioperative Outcomes in Septuagenarians and Octogenarians Undergoing Radical Cystectomy for Bladder Cancer-Do Outcomes Differ?. Eur Urol Focus. 2017; 4(6):895-899. DOI: 10.1016/j.euf.2017.08.005. View

19.

Brassetti A, Ragusa A, Tedesco F, Prata F, Cacciatore L, Iannuzzi A . Robotic Surgery in Urology: History from PROBOT to HUGO. Sensors (Basel). 2023; 23(16). PMC: 10458477. DOI: 10.3390/s23167104. View

20.

Cerantola Y, Valerio M, Persson B, Jichlinski P, Ljungqvist O, Hubner M . Guidelines for perioperative care after radical cystectomy for bladder cancer: Enhanced Recovery After Surgery (ERAS(®)) society recommendations. Clin Nutr. 2013; 32(6):879-87. DOI: 10.1016/j.clnu.2013.09.014. View