Factors Impacting the Occurrence of Local, Distant and Atypical Recurrences after Robot-Assisted Radical Cystectomy: A Detailed Analysis of 310 Patients.
Peritoneal carcinomatosis and extrapelvic lymph node metastases can be seen following robot-assisted radical cystectomy. In an attempt to identify predictors of these atypical metastases we report a detailed analysis of patients treated with robot-assisted radical cystectomy in whom recurrences developed.



A total of 310 patients underwent robot-assisted radical cystectomy for bladder cancer from 2001 to 2015. Descriptive statistics were used to compare baseline variables between patients without recurrence and those with local, distant or atypical recurrence. Univariate and multivariable regression models were used to assess the effect of variables on oncologic outcomes including recurrence location.



At a median followup of 24 months (IQR 14-51) 81 patients had recurrence. On multivariable analysis tumor classification, lymphovascular invasion, estimated glomerular filtration rate less than 60 ml/minute/1.73 m2and perioperative blood transfusion were significantly associated with any recurrence. Specific analyses showed that tumor and nodal classification, lymphovascular invasion and positive surgical margins were associated with all 3 recurrence locations (all p <0.05). Previous abdominal surgery was protective against atypical recurrences (HR 0.36, 95% CI 0.13-0.95, p = 0.04). Estimated glomerular filtration rate less than 60 ml/minute/1.73 m2and perioperative blood transfusion conferred a higher risk of distant or atypical recurrence but not of local recurrence (all p <0.05). Operative time and previous pelvic radiotherapy were not associated with any recurrence locations.



Predictors of distant recurrences, peritoneal carcinomatosis and extrapelvic lymph node metastases after robot-assisted radical cystectomy did not significantly differ and were mainly dictated by pathological tumor characteristics. Results suggest that the risk of atypical recurrence is chiefly influenced by tumor biology rather than surgical aspects.
Department of Urology, Bern University Hospital (DPN), Bern, Switzerland; Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York. Electronic address: daniel.nguyen@insel.ch.
Daniel P
DP
Nguyen
Department of Urology, Bern University Hospital (DPN), Bern, Switzerland; Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York.
Bashir
B
Al Hussein Al Awamlh
Department of Urology, Bern University Hospital (DPN), Bern, Switzerland; Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York.
Padraic
P
O'Malley
Department of Urology, Bern University Hospital (DPN), Bern, Switzerland; Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York.
Farehin
F
Khan
Department of Urology, Bern University Hospital (DPN), Bern, Switzerland; Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York.
Patrick J E
PJ
Lewicki
Department of Urology, Bern University Hospital (DPN), Bern, Switzerland; Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York.
David M
DM
Golombos
Department of Urology, Bern University Hospital (DPN), Bern, Switzerland; Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York.
Douglas S
DS
Scherr
D000368:Aged; D000369:Aged, 80 and over; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D010534:Peritoneal Neoplasms / Q000453:epidemiology* / Q000556:secondary*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D001749:Urinary Bladder Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000601:surgery*
cystectomy; neoplasm metastasis; recurrence; robotics; urinary bladder neoplasms