Hanna N, et al. - Using data from the National Cancer Data Base, researchers sought to comparatively inspect the effectiveness between robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC) in patients with localized muscle-invasive bladder cancer. The data brought to light an increased adoption of RARC between 2010 and 2013. It was noted that more than 1 out of 4 patients underwent RARC by the end of the study period. RARC exhibited a link with higher lymph nodes (LN) counts, shorter length of stay (LOS), and lower postoperative mortality (POM). Herein, the potential benefits of RARC were revealed.

Methods

• Patients with localized muscle-invasive bladder cancer who underwent RC between 2010 and 2013 were identified within the National Cancer Data Base.
• Patients underwent strtification based on the surgical approach: ORC vs. RARC.
• Intraoperative endpoints consisted of the presence of positive surgical margins, the performance of a pelvic lymph node dissection, and number of lymph nodes (LN) removed.
• Length of stay (LOS), 30- and 90-day postoperative mortality (POM) rates, 30-day readmission rate, and overall survival (OS) served as the postoperative endpoints.
• The observed differences in baseline characteristics between RARC vs. ORC patients were controlled for using weighted propensity scores in order to minimize selection bias.
• A scrutiny was conducted of the binary endpoints and OS using propensity score-adjusted logistic and Cox regression analyses, respectively.
• With the aid of propensity score weighted Kaplan-Meier survival estimates at 30 and 90 days after RC, POM was evaluated.

Results

• Among 9,561 patients who underwent RC, 2,048 (21.4%) and 7,513 (78.6%) underwent RARC and ORC, respectively.
• A rise was found in the use of RARC over time, from 16.7% in 2010 to 25.3% in 2013.
• RARC exhibited a link with equivalent rates of positive surgical margins (9.3% vs. 10.7%, odds ratio [OR] = 0.86, 95% CI: 0.72-1.03; P=0.10), higher rates of pelvic lymph node dissection (96.4% vs. 92.0%, OR = 2.30, 95% CI: 1.67-3.16; P < 0.001), higher median LN count (17 vs. 12, P < 0.001), higher rates of LN count above the median (56.8% vs. 40.4%, OR = 1.94, 95% CI: 1.55-2.42, P < 0.001), with regard to intraoperative outcomes.
• In terms of the postoperative outcomes, receipt of RARC correlated with a shorter median LOS (7 vs. 8, P < 0.001), and lower rates of pLOS (45.0% vs. 54.8%, OR = 0.68, 95% CI: 0.58-0.79; P < 0.001).
• The 30- and 90-day POM rates were discovered to be 2.8%, 6.7% for ORC, and 1.4%, 4.8% for RARC, respectively (hazard ratio [HR] = 0.48, 95% CI: 0.29-0.80, P=0.005 and HR = 0.71, 95% CI: 0.54-0.93; P=0.014).
• The IPTW-adjusted Cox regression analysis illustrated that RARC vs. ORC was related to a benefit in OS (HR = 0.79, 95% CI: 0.71-0.88; P < 0.001), with a mean follow-up of 26.9 months.