Factors Impacting the Occurrence of Local, Distant and Atypical Recurrences after Robot-Assisted Radical Cystectomy: A Detailed Analysis of 310 Patients

No AccessJournal of UrologyAdult Urology1 Nov 2016Factors Impacting the Occurrence of Local, Distant and Atypical Recurrences after Robot-Assisted Radical Cystectomy: A Detailed Analysis of 310 Patients Daniel P. Nguyen, Bashir Al Hussein Al Awamlh, Padraic O'Malley, Farehin Khan, Patrick J.E. Lewicki, David M. Golombos, and Douglas S. Scherr Daniel P. NguyenDaniel P. Nguyen , Bashir Al Hussein Al AwamlhBashir Al Hussein Al Awamlh , Padraic O'MalleyPadraic O'Malley , Farehin KhanFarehin Khan , Patrick J.E. LewickiPatrick J.E. Lewicki , David M. GolombosDavid M. Golombos , and Douglas S. ScherrDouglas S. Scherr View All Author Informationhttps://doi.org/10.1016/j.juro.2016.05.101AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: 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. Materials and Methods: 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. Results: 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 m2 and 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 m2 and 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. Conclusions: 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. 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Volume 196Issue 5November 2016Page: 1390-1396Supplementary Materials Advertisement Copyright & Permissions© 2016 by American Urological Association Education and Research, Inc.Keywordsroboticsneoplasm metastasisrecurrenceurinary bladder neoplasmscystectomyMetricsAuthor Information Daniel P. Nguyen More articles by this author Bashir Al Hussein Al Awamlh More articles by this author Padraic O'Malley More articles by this author Farehin Khan More articles by this author Patrick J.E. Lewicki More articles by this author David M. Golombos More articles by this author Douglas S. Scherr More articles by this author Expand All Advertisement PDF downloadLoading ...