title: Long-term oncologic outcomes following robot-assisted radical cystectomy: results from the International Robotic Cystectomy Consortium.
abstract: BACKGROUND
  Long-term oncologic data on patients undergoing robot-assisted radical cystectomy (RARC) are limited and based largely on single-institution series.
  
  
  OBJECTIVE
  Report survival outcomes of patients who underwent RARC ≥5 yr ago.
  
  
  METHODS
  Retrospective review of the prospectively populated International Robotic Cystectomy Consortium multi-institutional database identified 743 patients with RARC performed ≥5 yr ago. Clinical, pathologic, and survival data at the latest follow-up were collected. Patients with palliative RARC were excluded. Final analysis was performed on 702 patients from 11 institutions in 6 countries.
  
  
  METHODS
  RARC.
  
  
  METHODS
  Outcomes of interest, recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) were plotted using Kaplan-Meier survival curves. A Cox proportional hazards model was used to identify factors that predicted outcomes.
  
  
  CONCLUSIONS
  Pathologic organ-confined (OC) disease was found in 62% of patients. Soft tissue surgical margins (SMs) were positive in 8%. Median lymph node (LN) yield was 16, and 21% of patients had positive LNs. Median follow-up was 67 mo (interquartile range: 18-84 mo). Five-year RFS, CSS, and OS were 67%, 75%, and 50%, respectively. Non-OC disease and SMs were associated with poorer RFS, CSS, and OS on multivariable analysis. Age predicted poorer CSS and OS. Adjuvant chemotherapy and positive SMs were predictors of RFS (hazard ratio: 3.20 and 2.16; p<0.001 and p<0.005, respectively). Stratified survival curves demonstrated poorer outcomes for positive SM, LN, and non-OC disease. Retrospective interrogation and lack of contemporaneous comparison groups that underwent open radical cystectomy were major limitations.
  
  
  CONCLUSIONS
  The largest multi-institutional series to date reported long-term survival outcomes after RARC.
  
  
  RESULTS
  Patients who underwent robot-assisted radical cystectomy for bladder cancer have acceptable long-term survival.
authors.affiliation: Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Syed Johar
authors.initials: SJ
authors.lastname: Raza
authors.affiliation: City of Hope and Beckman Research Institute, Duarte, CA, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Wilson
authors.affiliation: Henry Ford Health System, Detroit, MI, USA.
authors.forename: James O
authors.initials: JO
authors.lastname: Peabody
authors.affiliation: Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Wiklund
authors.affiliation: Weill Cornell Medical College, New York, NY, USA.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Scherr
authors.affiliation: Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Ali
authors.initials: A
authors.lastname: Al-Daghmin
authors.affiliation: Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Shiva
authors.initials: S
authors.lastname: Dibaj
authors.affiliation: Guy's and St Thomas's Hospital, London, UK.
authors.forename: Muhammad Shamim
authors.initials: MS
authors.lastname: Khan
authors.affiliation: Guy's and St Thomas's Hospital, London, UK.
authors.forename: Prokar
authors.initials: P
authors.lastname: Dasgupta
authors.affiliation: Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium.
authors.forename: Alex
authors.initials: A
authors.lastname: Mottrie
authors.affiliation: Henry Ford Health System, Detroit, MI, USA.
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.affiliation: City of Hope and Beckman Research Institute, Duarte, CA, USA.
authors.forename: Bertram
authors.initials: B
authors.lastname: Yuh
authors.affiliation: Arthur Smith Institute for Urology, New Hyde Park, NY, USA.
authors.forename: Lee
authors.initials: L
authors.lastname: Richstone
authors.affiliation: University Clinics of Saarland, Homburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Saar
authors.affiliation: University Clinics of Saarland, Homburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Stoeckle
authors.affiliation: Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Abolfazl
authors.initials: A
authors.lastname: Hosseini
authors.affiliation: Cleveland Clinic Foundation, Cleveland, OH, USA.
authors.forename: Jihad
authors.initials: J
authors.lastname: Kaouk
authors.affiliation: Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: James L
authors.initials: JL
authors.lastname: Mohler
authors.affiliation: Yonsei University Health Systems Severance Hospital, Seoul, Korea.
authors.forename: Koon-Ho
authors.initials: KH
authors.lastname: Rha
authors.affiliation: Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Wilding
authors.affiliation: Roswell Park Cancer Institute, Buffalo, NY, USA. Electronic address: khurshid.guru@roswellpark.org.
authors.forename: Khurshid A
authors.initials: KA
authors.lastname: Guru
mesh_terms: D000368:Aged; D017024:Chemotherapy, Adjuvant; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*
keywords: Bladder cancer; Outcomes; Radical cystectomy; Recurrence; Robot-assisted; Robotic; Survival