title: Surgical control and margin status after robotic and open cystectomy in high-risk cases: Caution or equivalence?
abstract: OBJECTIVE
  The benefits of robotic-assisted radical cystectomy (RARC) are unclear, especially in patients with high-risk disease (pT3/T4). We evaluated pathological and postoperative outcomes of RARC versus open radical cystectomy (ORC) in these patients.
  
  
  METHODS
  We identified bladder cancer patients treated with RARC or ORC from January 2010-August 2014. Clinicodemographic factors were examined for potential confounding. Our primary outcome of interest was positive soft-tissue surgical margins (STSMs). Secondary outcomes included post-operative complications and length of stay (LOS). We used logistic regression to define the association between clinical factors with outcomes of interest, focusing on patients with locally advanced disease.
  
  
  RESULTS
  We identified 472 patients treated with ORC (407, 86.2 %) or RARC (65, 13.8 %) of which 215 (45.6 %) were high-risk cases based on advanced pathologic stage (pT3/4). RARC patients were more commonly men (96.9 vs. 73.2 %, p < 0.01), had better performance status (ECOG 0, 78.5 vs. 59.7 %, p = 0.031), and received less neoadjuvant chemotherapy (21.5 vs. 39.3 %, p = 0.006). Total (52.3 vs. 59.7 %, p = 0.26) and high-grade complication rates (13.8 vs. 19.7 %, p = 0.27) were similar, but median LOS was shorter after RARC (6 vs. 7 days, p < 0.01). On multivariate analysis, prior pelvic radiation (OR: 4.78, 95 % CI: 2.16-10.57), and advanced tumor stage (OR: 3.06, 95 % CI: 1.56-6.03) were independently associated with positive STSMs in high-risk patients but robotic surgical approach was not (OR: 0.81, 95 % CI: 0.29-2.30; p = 0.69).
  
  
  CONCLUSIONS
  RARC had similar short-term postoperative outcomes compared to ORC and did not compromise oncological control in patients with extravesical disease.
authors: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA.
authors: Pranav
authors: P
authors: Sharma
authors: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA.
authors: Kamran
authors: K
authors: Zargar-Shoshtari
authors: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA.
authors: Michael A
authors: MA
authors: Poch
authors: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA.
authors: Julio M
authors: JM
authors: Pow-Sang
authors: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA.
authors: Wade J
authors: WJ
authors: Sexton
authors: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA.
authors: Philippe E
authors: PE
authors: Spiess
authors: Department of Genitourinary Oncology, Moffitt Cancer Center, Tampa, FL, USA. scott.gilbert@moffitt.org.|Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, 12902 Magnolia, Tampa, FL, 33612, USA. scott.gilbert@moffitt.org.
authors: Scott M
authors: SM
authors: Gilbert
mesh_terms: D000368:Aged; D002295:Carcinoma, Transitional Cell / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000379:methods; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D000072662:Margins of Excision; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D010388:Pelvis; D011183:Postoperative Complications / Q000453:epidemiology; D011878:Radiotherapy; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*
keywords: Extravesical disease; High-risk; Minimally-invasive surgery; Radical cystectomy bladder cancer; Robotic-assisted