title: Oncologic Outcomes of Robot-Assisted Radical Cystectomy: Results of a High-Volume Robotic Center.
abstract: OBJECTIVE
  The aim of our study was to assess the oncologic outcomes of robot-assisted radical cystectomy (RARC) in patients with bladder cancer (BCa) treated in a high-volume robotic center.
  
  
  METHODS
  We retrospectively collected data of 155 consecutive patients who received RARC for urothelial BCa from January 2004 to May 2014. Kaplan-Meier analyses were used to assess time to recurrence, cancer-specific mortality (CSM) rate, and overall mortality rate. Uni- and multivariable Cox regression models addressed the predictors of recurrence and CSM.
  
  
  RESULTS
  Median follow-up for survivors was 42 months. Overall, 43%, 34%, 55%, and 18% of the patients had pT ≤1, pT2, pT3/4, and pN1-3 disease, respectively. Overall, 76% of the patients had high-grade disease at final pathology. The positive surgical margin rate was 9%. The 5-year recurrence-free, CSM-free, and overall survival estimates were 53.7%, 73.5%, and 65.2%, respectively. Among patients who experienced recurrence, 12.0%, 4.0%, and 84.0% had local, peritoneal, and distant recurrence, respectively. In multivariable Cox regression analyses, pathologic stage and nodal status represented independent predictors of recurrence and CSM (all p ≤ 0.04).
  
  
  CONCLUSIONS
  In a high-volume robotic center, RARC provides acceptable oncologic outcomes in patients with urothelial BCa. Tumor stage and nodal status represent independent predictors of recurrence and CSM in this setting.
authors.affiliation: 1 OLV Vattikuti Robotic Surgery Institute , Melle, Belgium .|2 Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele , Milan, Italy .|3 Department of Urology, Onze-Lieve-Vrouw Hospital , Aalst, Belgium .
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gandaglia
authors.affiliation: 3 Department of Urology, Onze-Lieve-Vrouw Hospital , Aalst, Belgium .
authors.forename: Ruben
authors.initials: R
authors.lastname: De Groote
authors.affiliation: 3 Department of Urology, Onze-Lieve-Vrouw Hospital , Aalst, Belgium .
authors.forename: Nicolas
authors.initials: N
authors.lastname: Geurts
authors.affiliation: 3 Department of Urology, Onze-Lieve-Vrouw Hospital , Aalst, Belgium .
authors.forename: Frederiek
authors.initials: F
authors.lastname: D'Hondt
authors.affiliation: 2 Unit of Urology, Division of Oncology, URI, IRCCS Ospedale San Raffaele , Milan, Italy .
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: 1 OLV Vattikuti Robotic Surgery Institute , Melle, Belgium .|4 Urology Clinic, Department of Surgery, Oncology, and Gastroenterology, University of Padua , Padua, Italy .
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.affiliation: 1 OLV Vattikuti Robotic Surgery Institute , Melle, Belgium .|3 Department of Urology, Onze-Lieve-Vrouw Hospital , Aalst, Belgium .
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mottrie
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D018572:Disease-Free Survival; D005260:Female; D061847:Hospitals, High-Volume; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000379:methods*; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods