title: Recurrence patterns after open and robot-assisted radical cystectomy for bladder cancer.
abstract: BACKGROUND
  Concerns remain whether robot-assisted radical cystectomy (RARC) compromises survival because of inadequate oncologic resection or alteration of recurrence patterns.
  
  
  OBJECTIVE
  To describe recurrence patterns following open radical cystectomy (ORC) and RARC.
  
  
  METHODS
  Retrospective review of 383 consecutive patients who underwent ORC (n=120) or RARC (n=263) at an academic institution from July 2001 to February 2014.
  
  
  METHODS
  ORC and RARC.
  
  
  METHODS
  Recurrence-free survival estimates were illustrated using the Kaplan-Meier method. Recurrence patterns (local vs distant and anatomic locations) within 2 yr of surgery were tabulated. Cox regression models were built to evaluate the effect of surgical technique on the risk of recurrence.
  
  
  CONCLUSIONS
  The median follow-up time for patients without recurrence was 30 mo (interquartile range [IQR] 5-72) for ORC and 23 mo (IQR 9-48) for RARC (p=0.6). Within 2 yr of surgery, there was no large difference in the number of local recurrences between ORC and RARC patients (15/65 [23%] vs 24/136 [18%]), and the distribution of local recurrences was similar between the two groups. Similarly, the number of distant recurrences did not differ between the groups (26/73 [36%] vs 43/147 [29%]). However, there were distinct patterns of distant recurrence. Extrapelvic lymph node locations were more frequent for RARC than ORC (10/43 [23%] vs 4/26 [15%]). Furthermore, peritoneal carcinomatosis was found in 9/43 (21%) RARC patients compared to 2/26 (8%) ORC patients. In multivariable analyses, RARC was not a predictor of recurrence. Limitations of the study include selection bias and a limited sample size.
  
  
  CONCLUSIONS
  Within limitations, we found that RARC is not an independent predictor of recurrence after surgery. Interestingly, extrapelvic lymph node locations and peritoneal carcinomatosis were more frequent in RARC than in ORC patients. Further validation is warranted to better understand the oncologic implications of RARC.
  
  
  RESULTS
  In this study, the locations of bladder cancer recurrences following conventional and robotic techniques for removal of the bladder are described. Although the numbers are small, the results show that the distribution of distant recurrences differs between the two techniques.
authors.affiliation: Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY, USA; Department of Urology, Bern University Hospital, Bern, Switzerland. Electronic address: danielphatnguyen@hotmail.com.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Nguyen
authors.affiliation: Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Bashir
authors.initials: B
authors.lastname: Al Hussein Al Awamlh
authors.affiliation: Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Xian
authors.initials: X
authors.lastname: Wu
authors.affiliation: Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Padraic
authors.initials: P
authors.lastname: O'Malley
authors.affiliation: Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Igor M
authors.initials: IM
authors.lastname: Inoyatov
authors.affiliation: Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Abimbola
authors.initials: A
authors.lastname: Ayangbesan
authors.affiliation: Department of Medicine, Division of Hematology/Medical Oncology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Bishoy M
authors.initials: BM
authors.lastname: Faltas
authors.affiliation: Department of Healthcare Policy and Research, Division of Biostatistics and Epidemiology, Weill Cornell Medical College, New York, NY, USA.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Christos
authors.affiliation: Department of Urology, Weill Cornell Medical College-New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Scherr
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D015331:Cohort Studies; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D010534:Peritoneal Neoplasms / Q000453:epidemiology* / Q000556:secondary; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000469:parasitology / Q000601:surgery*
keywords: Bladder cancer; Distant; Local; Open radical cystectomy; Recurrence; Robot-assisted radical cystectomy