Survival after radical cystectomy for bladder cancer: Multicenter comparison between minimally invasive and open approaches

doi:10.1016/j.ajur.2020.06.002

Asian Journal of Urology, 2020, 7 (3): 291-300 doi: 10.1016/j.ajur.2020.06.002

Asian Focus

Survival after radical cystectomy for bladder cancer: Multicenter comparison between minimally invasive and open approaches

Weibin Xie^a,b,Junming Bi^a,b,Qiang Wei^c,Ping Han^c,Dongkui Song^d,Lei Shi^d,Dingwei Ye^e,f,Yijun Shen^e,f,Xin Gou^g,Weiyang He^g,Shaogang Wang^h,Zheng Liu^h,Jinhai Fanⁱ,Kaijie Wuⁱ,Zhiwen Chen^j,Xiaozhou Zhou^j,Chuize Kong^k,Yang Liu^k,Chunxiao Liu^l,Abai Xu^l,Baiye Jin^m,Guanghou Fu^m,Wei Xueⁿ,Haige Chenⁿ,Tiejun Pan^o,Zhong Tu^o,Tianxin Lin^a,b,*(

),Jian Huang^a,b,*(

)

^a Department of Urology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
^b Guangdong Provincial Key Laboratory of Malignant Tumor Epigenetics and Gene Regulation, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
^c Department of Urology, West China Hospital, Sichuan University, Chengdu, China
^d Department of Urology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
^e Department of Urology, Fudan University Shanghai Cancer Center, Shanghai, China
^f Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
^g Department of Urology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
^h Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
ⁱ Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
^j Department of Urology, First Affiliated Hospital of Army Medical University, Urology Institute of People Liberation Army, Chongqing, China
^k Department of Urology, The First Hospital of China Medical University, Shenyang, China
^l Department of Urology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
^m Department of Urology, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
ⁿ Department of Urology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
^o Department of Urology, General Hospital of Central Theater Command of the People's Liberation Army, Wuhan, China

Abstract
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Abstract

Objective: To investigate oncological outcomes in patients with bladder cancer who underwent minimally invasive radical cystectomy (MIRC) or open radical cystectomy (ORC).
Methods: We identified patients with bladder cancer who underwent radical cystectomy (RC) in 13 centers of the Chinese Bladder Cancer Consortium (CBCC). Perioperative outcomes were compared between MIRC and ORC. The influence of surgical approaches on overall survival (OS) and cancer-specific survival (CSS) in the entire study group and subgroups classified according to pathologic stage or lymph node (LN) status was assessed with the log-rank test. Multivariable Cox proportional hazard models were used to evaluate the association among OS, CSS and risk factors of interest.
Results: Of 2 098 patients who underwent RC, 1 243 patients underwent MIRC (1 087 laparoscopic RC and 156 robotic-assisted RC, respectively), while 855 patients underwent ORC. No significant differences were noted in positive surgical margin rate and 90-day postoperative mortality rate. MIRC was associated with less estimated blood loss, more LN yield, higher rate of neobladder diversion, longer operative time, and longer length of hospital stay. There was no significant difference in OS and CSS according to surgical approaches (p=0.653, and 0.816, respectively). Subgroup analysis revealed that OS and CSS were not significantly different regardless of the status of extravesical involvement or LN involvement. Multivariable Cox regression analyses showed that the surgical approach was not a significant predictor of OS and CSS.
Conclusions: Our study showed that MIRC was comparable to conventional ORC in terms of OS and CSS.

Key words： Bladder cancer Radical cystectomy Minimally invasive surgery Robotic surgery Laparoscopy

Received: 12 November 2019 Available online: 20 July 2020

Corresponding Authors: Tianxin Lin,Jian Huang E-mail: lintx@mail.sysu.edu.cn;urolhj@sina.com

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	Weibin Xie
	Junming Bi
	Qiang Wei
	Ping Han
	Dongkui Song
	Lei Shi
	Dingwei Ye
	Yijun Shen
	Xin Gou
	Weiyang He
	Shaogang Wang
	Zheng Liu
	Jinhai Fan
	Kaijie Wu
	Zhiwen Chen
	Xiaozhou Zhou
	Chuize Kong
	Yang Liu
	Chunxiao Liu
	Abai Xu
	Baiye Jin
	Guanghou Fu
	Wei Xue
	Haige Chen
	Tiejun Pan
	Zhong Tu
	Tianxin Lin
	Jian Huang

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Cite this article:

Weibin Xie,Junming Bi,Qiang Wei, et al. Survival after radical cystectomy for bladder cancer: Multicenter comparison between minimally invasive and open approaches[J]. Asian Journal of Urology, 2020, 7(3): 291-300.

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http://www.ajurology.com/EN/10.1016/j.ajur.2020.06.002 OR http://www.ajurology.com/EN/Y2020/V7/I3/291

Flowchart diagram depicting patient selection. PLND, pelvic lymph node dissection; CBCC, Chinese Bladder Cancer Consortium; MIRC, minimally invasive radical cystectomy; ORC, open radical cystectomy.

Patient and tumor characteristics.

Perioperative outcomes.

Survival of the whole patient group underwent radical cystectomy, stratified by surgical approach (MIRC or ORC). (A) Overall survival (OS); (B) Cancer-specific survival (CSS). MIRC, minimally invasive radical cystectomy; ORC, open radical cystectomy.

Survival of patients with organ-confined cancer (≤pT2), stratified by surgical approach (MIRC or ORC). (A) Overall survival (OS); (B) Cancer-specific survival (CSS). MIRC, minimally invasive radical cystectomy; ORC, open radical cystectomy.

Survival of patients with extravesical involvement (≥pT3), stratified by surgical approach (MIRC or ORC). (A) Overall survival (OS); (B) Cancer-specific survival (CSS). MIRC, minimally invasive radical cystectomy; ORC, open radical cystectomy.

Survival of patients without lymph node involvement (LN-positive), stratified by surgical approach (MIRC or ORC). (A) Overall survival (OS); (B) Cancer-specific survival (CSS). MIRC, minimally invasive radical cystectomy; ORC, open radical cystectomy.

Survival of patients with lymph node involvement (LN+), stratified by surgical approach (MIRC or ORC). (A) Overall survival (OS); (B) Cancer-specific survival (CSS). MIRC, minimally invasive radical cystectomy; ORC, open radical cystectomy.

Multivariable Cox proportional hazard regression analyses.

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