Robot-Assisted Radical Cystectomy with Intracorporeal Urine Derivation: Analysis of 3-Year Survival Outcomes
Abstract
Over 500,000 cases of bladder cancer are reported annually. The gold standard for treatment of muscle-invasive bladder cancer is radical cystectomy (RC) with pelvic lymphadenectomy (PLAE), but the method has a high risk of complications. The robotassisted radical cystectomy (RARC), first performed in 2003, requires an assessment of long-term outcomes, including overall, tumor-specific, and disease-free survival.
Objective. To determine overall, tumor-specific, and disease-free survival after RARC with PLAE in patients with muscleinvasive bladder cancer.
Material and methods. The study included 200 patients (2018-2023) who were followed up for 36 months. The survival rate was analyzed using Kaplan-Meier curves, including stratification by pN status.
Results. After 36 months, overall survival was 48.25%, tumor-specific survival – 57.49%, disease-free survival – 61.89% (p=0.0031). In pN(+) patients, the indices were significantly lower (p<0.0001), which correlates with a higher pT stage.
Conclusion. RARC demonstrates satisfactory oncological efficacy. The main factors in reducing survival are lymph node damage and local tumor progression.
About the Authors
V. N. Pavlov
ФГБОУ ВО «Башкирский государственный медицинский университет» Минздрава России
Russian Federation
Russian Federation
M. F. Urmantsev
ФГБОУ ВО «Башкирский государственный медицинский университет» Минздрава России
Russian Federation
Russian Federation
V. N. Dubrovin
ГБУ РМЭ «Республиканская клиническая больница»; ФГОУ ВО «Казанский государственный медицинский университет» Минздрава России
Russian Federation
Russian Federation
References
1. Richters A, Aben KKH, Kiemeney LALM. The global burden of urinary bladder cancer: an update. World J Urol. 2020 Aug;38(8):1895-1904. (in Engl) doi: 10.1007/s00345-019-02984-4.
2. Lenis AT, Lec PM, Chamie K, [et al.] Bladder Cancer: A Review. JAMA. 2020 Nov 17;324(19):1980-1991. (in Engl)
3. Khasanova G. M., Yangurazova Z. A. Toxic and essential microelements in the human body of a large industrial city. Ecology of urbanized territories. 2007;3:28-30.(In Russ)
4. Chang SS, Bochner BH, Chou R, [et al.] Treatment of Nonmetastatic Muscle-Invasive Bladder Cancer: American Urological Association/American Society of Clinical Oncology/American Society for Radiation Oncology/Society of Urologic Oncology Clinical Practice Guideline Summary. J Oncol Pract. 2017 Sep;13(9):621-625. (in Engl) doi: 10.1200/JOP.2017.024919.
5. Tan WS, Lamb BW, Tan MY, [et al.] In-depth Critical Analysis of Complications Following Robot-assisted Radical Cystectomy with Intracorporeal Urinary Diversion. Eur Urol Focus. 2017 Apr;3(2-3):273-279. (in Engl) doi: 10.1016/j.euf.2016.06.002.
6. van Hemelrijck M, Thorstenson A, Smith P, [et al.] Risk of in-hospital complications after radical cystectomy for urinary bladder carcinoma: population-based follow-up study of 7608 patients. BJU Int. 2013 Dec;112(8):1113-20. (in Engl) doi: 10.1111/bju.12239.
7. Alfred Witjes J, Lebret T, Compérat EM, [et al.] Updated 2016 EAU Guidelines on Muscle-invasive and Metastatic Bladder Cancer. Eur Urol. 2017 Mar;71(3):462-475. (in Engl) doi: 10.1016/j.eururo.2016.06.020.
8. Parekh DJ, Reis IM, Castle EP, [et al.] Robot-assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer (RAZOR): an open-label, randomised, phase 3, non-inferiority trial. Lancet. 2018 Jun 23;391(10139):2525-2536. (in Engl) doi: 10.1016/S0140-6736(18)30996-6.
9. Menon M, Hemal AK, Tewari A, [et al.] Nerve-sparing robot-assisted radical cystoprostatectomy and urinary diversion. BJU Int. 2003 Aug;92(3):232-6. (in Engl) doi: 10.1046/j.1464-410x.2003.04329.x.
10. Mitra AP, Cai J, Miranda G, [et al.] Management Trends and Outcomes of Patients Undergoing Radical Cystectomy for Urothelial Carcinoma of the Bladder: Evolution of the University of Southern California Experience over 3,347 Cases. J Urol. 2022 Feb;207(2):302- 313. (in Engl) doi: 10.1097/JU.0000000000002242.
11. Tamhankar AS, Thurtle D, Hampson A, [et al.] Radical Cystectomy in England from 2013 to 2019 on 12,644 patients: An analysis of national trends and comparison of surgical approaches using Hospital Episode Statistics data. BJUI Compass. 2021 Mar 12;2(5):338- 347. (in Engl) doi: 10.1002/bco2.79.
12. Liu H, Zhou Z, Yao H, [et al.] Robot-assisted radical cystectomy vs open radical cystectomy in patients with bladder cancer: a systematic review and meta-analysis of randomized controlled trials. World J Surg Oncol. 2023 Aug 5;21(1):240. (in Engl) doi: 10.1186/s12957-023-03132-4.
13. Riveros C, Ranganathan S, Nipper C, [et al.] Open vs. robot-assisted radical cystectomy with extracorporeal or intracorporeal urinary diversion for bladder cancer A pairwise meta-analysis of outcomes and a network meta-analysis of complications. Can Urol Assoc J. 2023 Mar;17(3):E75-E85. (in Engl) doi: 10.5489/cuaj.8096.
14. Tyritzis SI, Collins JW, Wiklund NP. The current status of robot-assisted cystectomy. Indian J Urol. 2018 Apr-Jun;34(2):101-109. (in Engl) doi: 10.4103/iju.IJU_355_17.
15. Wijburg CJ, Hannink G, Michels CTJ, [et al.] Learning Curve Analysis for Intracorporeal Robot-assisted Radical Cystectomy: Results from the EAU Robotic Urology Section Scientific Working Group. Eur Urol Open Sci. 2022 Apr 2;39:55-61. (in Engl) doi: 10.1016/j.euros.2022.03.004.
16. Hussein AA, May PR, Jing Z, [et al.] Outcomes of Intracorporeal Urinary Diversion after Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium. J Urol. 2018 May;199(5):1302-1311. (in Engl) doi: 10.1016/j.juro.2017.12.045.
17. Mortezavi A Morbidity and Mortality After Robot-assisted Radical Cystectomy with Intracorporeal Urinary Diversion in the Elderly / Mortezavi A., Crippa A., Edeling S., [et al.] Eur Urol Onc 2021 - DOI: 10.1016/j.euo.2021.06.006
18. Yuh B. Robot-assisted Radical Cystectomy vs Open Radical Cystectomy: A Propensity Score-matched Analysis of Complications and Perioperative Outcomes / Yuh B., Wilson T., Bochner B., [et al.] Urol Onco 2022 – doi:10.1016/j.eururo.2022.12.008
19. Hussein A.A 10-Year Oncologic Outcomes After Robot-Assisted Radical Cystectomy: Results from the International Multicenter Cystectomy Consortium (IMCC) / Hussein A.A., Elsayed A.S., Aldhaam N.A., [et al.] 2023 DOI: 10.1016/j.eururo.2023.03.023
Review
For citations:
Pavlov V.N., Urmantsev M.F., Dubrovin V.N. Robot-Assisted Radical Cystectomy with Intracorporeal Urine Derivation: Analysis of 3-Year Survival Outcomes. Bashkortostan Medical Journal. 2025;20(2):98-103. (In Russ.)
Views:
5
Email this article 
