title: Analysis of open and intracorporeal robotic assisted radical cystectomy shows no significant difference in recurrence patterns and oncological outcomes.
abstract: To report and compare early oncological outcomes and cancer recurrence sites among patients undergoing open radical cystectomy (ORC) and robotic-assisted radical cystectomy with intracorporeal urinary diversion (iRARC).
  
  
  
  A total of 184 patients underwent radical cystectomy for bladder cancer. ORC cases (n = 94) were performed between June 2005 and July 2014 while iRARC cases (n = 90) were performed between June 2011 and July 2014. Primary outcome was recurrence free survival (RFS). Secondary outcomes were sites of local and metastatic recurrence, cancer specific survival (CSS) and overall survival (OS).
  
  
  
  Median follow-up for patients without recurrence was 33.8 months (interquartile range [IQR]: 20.5-45.4) for ORC; and 16.1 months (IQR: 11.2-27.0) for iRARC. No significant difference in age, sex, precystectomy T stage, precystectomy grade, or lymph node yield between ORC and iRARC was observed. The ORC cohort included more patients with≥pT2 (64.8% ORC vs. 38.9% iRARC) but fewer pT0 status (8.5% ORC vs.vs. 22.2% iRARC) due to lower preoperative chemotherapy use (22.3% ORC vs. 34.4% iRARC). Positive surgical margin rate was significantly higher in the ORC cohort (19.3% vs. 8.2%; P = 0.042). Kaplan-Meir analysis showed no significant difference in RFS (69.5% ORC vs. 78.8% iRARC), cancer specific survival (80.9% ORC vs. 84.4% iRARC), or OS (73.5% ORC vs.vs. iRARC 83.8%) at 24 months. Cox regression analysis showed RFS, cancer specific survival and OS were not influenced by cystectomy technique. No significant difference between local and metastatic RFS between ORC and iRARC was observed.
  
  
  
  This study has found no difference in recurrence patterns or oncological outcomes between ORC and iRARC. Recurrent metastatic sites vary, but are not related to surgical technique.
authors.affiliation: Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK. Electronic address: wei.tan@ucl.ac.uk.
authors.forename: Wei Shen
authors.initials: WS
authors.lastname: Tan
authors.affiliation: Department of Urology, University College London Hospital, London, UK.
authors.forename: Ashwin
authors.initials: A
authors.lastname: Sridhar
authors.affiliation: Department of Urology, Chase Farm & Barnet Hospitals, London, UK.
authors.forename: Gidon
authors.initials: G
authors.lastname: Ellis
authors.affiliation: Department of Urology, University College London Hospital, London, UK.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Lamb
authors.affiliation: Department of Urology, University College London Hospital, London, UK.
authors.forename: Miles
authors.initials: M
authors.lastname: Goldstraw
authors.affiliation: Department of Urology, University College London Hospital, London, UK.
authors.forename: Senthil
authors.initials: S
authors.lastname: Nathan
authors.affiliation: Department of Urology, University College London Hospital, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Hines
authors.affiliation: Department of Urology, University College London Hospital, London, UK.
authors.forename: Paul
authors.initials: P
authors.lastname: Cathcart
authors.affiliation: Department of Urology, University College London Hospital, London, UK; Department of Urology, Chase Farm & Barnet Hospitals, London, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Briggs
authors.affiliation: Division of Surgery and Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital, London, UK.
authors.forename: John
authors.initials: J
authors.lastname: Kelly
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*
keywords: Bladder cancer; Intracorporeal urinary diversion; Open cystectomy; Outcomes; Recurrence; Robotic-assisted cystectomy