Oncological and functional outcomes of robotassisted radical cystectomy in bladder cancer patients in a single tertiary center: Can these be preserved throughout the learning curve?

Jong Hyun Tae, Jong Hyun Pyun, Ji Sung Shim, Seok Cho, Sung Gu Kang, Young Hwii Ko, Jun Cheon, Jeong Gu Lee, Seok Ho Kang

Research output: Contribution to journalArticle

Abstract

Purpose: To evaluate the overall and segmental oncological and functional outcome of robot-assisted radical cystectomy (RARC) during the learning curve. Materials and Methods: From August 2007 to November 2017, a total of 120 bladder cancer patients were treated with RARC in a single-tertiary hospital. These were divided into three groups of 40 consecutive cases. Overall and subgroup analysis of each group was used to evaluate oncological and functional outcomes throughout the learning curve. Results: Among the 120 RARC cases, 42, 73, and 5 patients received extracorporeal urinary diversion (ECUD), intracorporeal urinary diversion (ICUD), and ureterocutaneostomy, respectively. There was a transition from ECUD to ICUD during the learning curve. The positive surgical margin rate was 0.8%. The mean lymph node yield for the standard and extended pelvic lymph node dissection was 12.5 and 30.1, respectively, and increased to 19.8 and 31.2 and further to 20.0 and 37.9, respectively, with each additional series of 40 cases. The 5-year overall survival and 3-year recurrence-free survival rates were 86.6% and 81.4%, respectively. The 1-year daytime continence rate was 75.7%, while the nighttime continence rate was 51.4%. The potency preservation rate was 66.7% (n=8) with or without phosphodiesterase-5 inhibitors (PDE5-I) at 1 year and 33.3% without PDE5-I (n=4). Conclusions: RARC results in comparable oncological and functional outcomes to open radical cystectomy. In addition, the oncological and functional outcomes were well maintained throughout the learning curve. ECUD transition to ICUD was safe and did not compromise oncological or functional outcome.

Original languageEnglish
Pages (from-to)463-471
Number of pages9
JournalInvestigative and Clinical Urology
Volume60
Issue number6
DOIs
Publication statusPublished - 2019 Nov

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Urinary Diversion
Learning Curve
Cystectomy
Urinary Bladder Neoplasms
Phosphodiesterase 5 Inhibitors
Lymph Node Excision
Tertiary Care Centers
Survival Rate
Lymph Nodes
Recurrence
Survival

Keywords

  • Cystectomy
  • Robotics
  • Urinary bladder neoplasms

ASJC Scopus subject areas

  • Urology

Cite this

@article{de5cb1ae6c734c819c558d8b517f9972,
title = "Oncological and functional outcomes of robotassisted radical cystectomy in bladder cancer patients in a single tertiary center: Can these be preserved throughout the learning curve?",
abstract = "Purpose: To evaluate the overall and segmental oncological and functional outcome of robot-assisted radical cystectomy (RARC) during the learning curve. Materials and Methods: From August 2007 to November 2017, a total of 120 bladder cancer patients were treated with RARC in a single-tertiary hospital. These were divided into three groups of 40 consecutive cases. Overall and subgroup analysis of each group was used to evaluate oncological and functional outcomes throughout the learning curve. Results: Among the 120 RARC cases, 42, 73, and 5 patients received extracorporeal urinary diversion (ECUD), intracorporeal urinary diversion (ICUD), and ureterocutaneostomy, respectively. There was a transition from ECUD to ICUD during the learning curve. The positive surgical margin rate was 0.8{\%}. The mean lymph node yield for the standard and extended pelvic lymph node dissection was 12.5 and 30.1, respectively, and increased to 19.8 and 31.2 and further to 20.0 and 37.9, respectively, with each additional series of 40 cases. The 5-year overall survival and 3-year recurrence-free survival rates were 86.6{\%} and 81.4{\%}, respectively. The 1-year daytime continence rate was 75.7{\%}, while the nighttime continence rate was 51.4{\%}. The potency preservation rate was 66.7{\%} (n=8) with or without phosphodiesterase-5 inhibitors (PDE5-I) at 1 year and 33.3{\%} without PDE5-I (n=4). Conclusions: RARC results in comparable oncological and functional outcomes to open radical cystectomy. In addition, the oncological and functional outcomes were well maintained throughout the learning curve. ECUD transition to ICUD was safe and did not compromise oncological or functional outcome.",
keywords = "Cystectomy, Robotics, Urinary bladder neoplasms",
author = "Tae, {Jong Hyun} and Pyun, {Jong Hyun} and Shim, {Ji Sung} and Seok Cho and Kang, {Sung Gu} and Ko, {Young Hwii} and Jun Cheon and Lee, {Jeong Gu} and Kang, {Seok Ho}",
year = "2019",
month = "11",
doi = "10.4111/icu.2019.60.6.463",
language = "English",
volume = "60",
pages = "463--471",
journal = "Investigative and Clinical Urology",
issn = "2466-0493",
publisher = "Korean Urological Association",
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TY - JOUR

T1 - Oncological and functional outcomes of robotassisted radical cystectomy in bladder cancer patients in a single tertiary center

T2 - Can these be preserved throughout the learning curve?

AU - Tae, Jong Hyun

AU - Pyun, Jong Hyun

AU - Shim, Ji Sung

AU - Cho, Seok

AU - Kang, Sung Gu

AU - Ko, Young Hwii

AU - Cheon, Jun

AU - Lee, Jeong Gu

AU - Kang, Seok Ho

PY - 2019/11

Y1 - 2019/11

N2 - Purpose: To evaluate the overall and segmental oncological and functional outcome of robot-assisted radical cystectomy (RARC) during the learning curve. Materials and Methods: From August 2007 to November 2017, a total of 120 bladder cancer patients were treated with RARC in a single-tertiary hospital. These were divided into three groups of 40 consecutive cases. Overall and subgroup analysis of each group was used to evaluate oncological and functional outcomes throughout the learning curve. Results: Among the 120 RARC cases, 42, 73, and 5 patients received extracorporeal urinary diversion (ECUD), intracorporeal urinary diversion (ICUD), and ureterocutaneostomy, respectively. There was a transition from ECUD to ICUD during the learning curve. The positive surgical margin rate was 0.8%. The mean lymph node yield for the standard and extended pelvic lymph node dissection was 12.5 and 30.1, respectively, and increased to 19.8 and 31.2 and further to 20.0 and 37.9, respectively, with each additional series of 40 cases. The 5-year overall survival and 3-year recurrence-free survival rates were 86.6% and 81.4%, respectively. The 1-year daytime continence rate was 75.7%, while the nighttime continence rate was 51.4%. The potency preservation rate was 66.7% (n=8) with or without phosphodiesterase-5 inhibitors (PDE5-I) at 1 year and 33.3% without PDE5-I (n=4). Conclusions: RARC results in comparable oncological and functional outcomes to open radical cystectomy. In addition, the oncological and functional outcomes were well maintained throughout the learning curve. ECUD transition to ICUD was safe and did not compromise oncological or functional outcome.

AB - Purpose: To evaluate the overall and segmental oncological and functional outcome of robot-assisted radical cystectomy (RARC) during the learning curve. Materials and Methods: From August 2007 to November 2017, a total of 120 bladder cancer patients were treated with RARC in a single-tertiary hospital. These were divided into three groups of 40 consecutive cases. Overall and subgroup analysis of each group was used to evaluate oncological and functional outcomes throughout the learning curve. Results: Among the 120 RARC cases, 42, 73, and 5 patients received extracorporeal urinary diversion (ECUD), intracorporeal urinary diversion (ICUD), and ureterocutaneostomy, respectively. There was a transition from ECUD to ICUD during the learning curve. The positive surgical margin rate was 0.8%. The mean lymph node yield for the standard and extended pelvic lymph node dissection was 12.5 and 30.1, respectively, and increased to 19.8 and 31.2 and further to 20.0 and 37.9, respectively, with each additional series of 40 cases. The 5-year overall survival and 3-year recurrence-free survival rates were 86.6% and 81.4%, respectively. The 1-year daytime continence rate was 75.7%, while the nighttime continence rate was 51.4%. The potency preservation rate was 66.7% (n=8) with or without phosphodiesterase-5 inhibitors (PDE5-I) at 1 year and 33.3% without PDE5-I (n=4). Conclusions: RARC results in comparable oncological and functional outcomes to open radical cystectomy. In addition, the oncological and functional outcomes were well maintained throughout the learning curve. ECUD transition to ICUD was safe and did not compromise oncological or functional outcome.

KW - Cystectomy

KW - Robotics

KW - Urinary bladder neoplasms

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