title: Early Oncologic Failure after Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium.
abstract: We sought to investigate the prevalence and variables associated with early oncologic failure.
  
  
  
  We retrospectively reviewed the IRCC (International Radical Cystectomy Consortium) database of patients who underwent robot-assisted radical cystectomy since 2003. The final cohort comprised a total of 1,894 patients from 23 institutions in 11 countries. Early oncologic failure was defined as any disease relapse within 3 months of robot-assisted radical cystectomy. All institutions were surveyed for the pneumoperitoneum pressure used, breach of oncologic surgical principles, and techniques of specimen and lymph node removal. A multivariate model was fit to evaluate predictors of early oncologic failure. The Kaplan-Meier method was applied to depict disease specific and overall survival, and Cox proportional regression analysis was used to evaluate predictors of disease specific and overall survival.
  
  
  
  A total of 305 patients (22%) experienced disease relapse, which was distant in 220 (16%), local recurrence in 154 (11%), peritoneal carcinomatosis in 17 (1%) and port site recurrence in 5 (0.4%). Early oncologic failure developed in 71 patients (5%) at a total of 10 institutions. The incidence of early oncologic failure decreased from 10% in 2006 to 6% in 2015. On multivariate analysis the presence of any complication (OR 2.87, 95% CI 1.38-5.96, p = 0.004), pT3 or greater disease (OR 3.73, 95% CI 2.00-6.97, p <0.001) and nodal involvement (OR 2.14, 95% CI 1.21-3.80, p = 0.008) was a significant predictor of early oncologic failure. Patients with early oncologic failure demonstrated worse disease specific and overall survival (23% and 13%, respectively) at 1 and 3 years compared to patients who experienced later or no recurrences (log rank p <0.001).
  
  
  
  The incidence of early oncologic failure following robot-assisted radical cystectomy has decreased with time. Disease related rather than technical related factors have a major role in early oncologic failure after robot-assisted radical cystectomy.
authors.affiliation: Roswell Park Cancer Institute, Buffalo, New York; Cairo University, Cairo, Egypt.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Hussein
authors.affiliation: University of the Saarland, Homburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Saar
authors.affiliation: Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: Paul R
authors.initials: PR
authors.lastname: May
authors.affiliation: Rijnstate Hospital, Arnhem, the Netherlands.
authors.forename: Carl J
authors.initials: CJ
authors.lastname: Wijburg
authors.affiliation: Arthur Smith Institute for Urology, New York, New York.
authors.forename: Lee
authors.initials: L
authors.lastname: Richstone
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, Massachusetts.
authors.forename: Andrew
authors.initials: A
authors.lastname: Wagner
authors.affiliation: City of Hope and Beckman Research Institute, Duarte, California.
authors.forename: Timothy
authors.initials: T
authors.lastname: Wilson
authors.affiliation: City of Hope and Beckman Research Institute, Duarte, California.
authors.forename: Bertram
authors.initials: B
authors.lastname: Yuh
authors.affiliation: Fundació Puigvert, Barcelona, Spain.
authors.forename: Joan Palou
authors.initials: JP
authors.lastname: Redorta
authors.affiliation: Guy's Hospital and King's College, London School of Medicine, London, United Kingdom.
authors.forename: Prokar
authors.initials: P
authors.lastname: Dasgupta
authors.affiliation: Guy's Hospital and King's College, London School of Medicine, London, United Kingdom.
authors.forename: Mohammad Shamim
authors.initials: MS
authors.lastname: Khan
authors.affiliation: Henry Ford Health System, Detroit, Michigan.
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.affiliation: Henry Ford Health System, Detroit, Michigan.
authors.forename: James O
authors.initials: JO
authors.lastname: Peabody
authors.affiliation: Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Abolfazl
authors.initials: A
authors.lastname: Hosseini
authors.affiliation: Luigi Sacco University Hospital, Milan, Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Gaboardi
authors.affiliation: Onze-Lieve-Vrouw Ziekenhuis, Aalast, Belgium.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Mottrie
authors.affiliation: Yonsei University Health System Severance Hospital, Seoul, Korea.
authors.forename: Koon-Ho
authors.initials: KH
authors.lastname: Rha
authors.affiliation: Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina.
authors.forename: Ashok
authors.initials: A
authors.lastname: Hemal
authors.affiliation: University of the Saarland, Homburg, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Stockle
authors.affiliation: Division of Surgery and Interventional Science, Department of Urology, University College London, London, United Kingdom.
authors.forename: John
authors.initials: J
authors.lastname: Kelly
authors.affiliation: Michigan Urological Clinic, Grand Rapids, Michigan.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Maatman
authors.affiliation: Yildirim Beyazit University, School of Medicine, Ankara Ataturk Training and Research Hospital, Ankara, Turkey.
authors.forename: Abdullah Erdem
authors.initials: AE
authors.lastname: Canda
authors.affiliation: Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Peter
authors.initials: P
authors.lastname: Wiklund
authors.affiliation: Roswell Park Cancer Institute, Buffalo, New York. Electronic address: Khurshid.guru@roswellpark.org.
authors.forename: Khurshid A
authors.initials: KA
authors.lastname: Guru
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D013997:Time Factors; D017211:Treatment Failure; D001749:Urinary Bladder Neoplasms / Q000601:surgery*
keywords: cystectomy; local; neoplasm recurrence; robotic surgical procedures; treatment failure; urinary bladder neoplasms