MP21-13 DOES QUALITY OF CARE IMPACT OUTCOMES IN PATIENTS WITH LOCALLY ADVANCED BLADDER CANCER AFTER ROBOT-ASSISTED RADICAL CYSTECTOMY?

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive I1 Apr 2017MP21-13 DOES QUALITY OF CARE IMPACT OUTCOMES IN PATIENTS WITH LOCALLY ADVANCED BLADDER CANCER AFTER ROBOT-ASSISTED RADICAL CYSTECTOMY? Youssef Ahmed, Ahmed Hussein, Paul May, Basel Ahmed, Amir Khan, John Binkowski, Justen Kozlowski, and Khurshid Guru Youssef AhmedYoussef Ahmed More articles by this author , Ahmed HusseinAhmed Hussein More articles by this author , Paul MayPaul May More articles by this author , Basel AhmedBasel Ahmed More articles by this author , Amir KhanAmir Khan More articles by this author , John BinkowskiJohn Binkowski More articles by this author , Justen KozlowskiJusten Kozlowski More articles by this author , and Khurshid GuruKhurshid Guru More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.3275AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Lack of tactile feedback and potential higher risk of positive margins may advocate against the use of Robot-assisted Radical Cystectomy (RARC) for Locally advanced disease (LAD). We evaluated the quality of RARC in patients with LAD and compared it to organ-confined disease (OCD) METHODS Retrospective review of 421 consecutive RARCs between 2005 and 2015 was performed. Patients with LAD (>=pT3 and/or N+) were compared with OCD (<=pT2/N0). Validated Quality Cystectomy Score (QCS) based on 4 sets of quality metrics was used to compare surgical performance in both groups: [I- Preoperative (Administration of Neoadjuvant Chemotherapy); II- Operative (Overall operative time (< 6.5 hours) and estimated blood loss less <500 ml); III- Pathologic (Negative Soft Tissue Surgical Margins and Lymph Node Yield>20); and IV- Peri-operative (No high grade complications, Readmission or Mortality within 30-d)]. Star Scores were assigned according to the number of criteria achieved. Kaplan Meier method was used to compute recurrence free (RFS), cancer-specific (CSS) and overall survival (OS) rates. Cox proportional hazards model were fit to evaluate predictors of survival. RESULTS 52% had LAD. They had fewer neobladders (3% vs 12%, p<0.001), received adjuvant chemotherapy more frequently (34% vs 4%, p<0.001), and experienced higher mortality within 90 d of RARC (8% vs 1%, p=0.001). LAD patients showed more positive surgical margins (18% vs 2%, p<0.001) and developed recurrences more frequently (41% vs 13%, p<0.001). There was no significant difference in complications or readmissions. Patients with OCD exhibited better 3-year RFS, DSS and OS (85% vs 47%, 96% vs 65% and 81% vs 28%, respectively) (Figure 1). 91% of OCD patients achieved >=3 stars in comparison to 81% in LAD (Table 1). For OCD, patients who achieved star score of 3 or 4 remained stable (approximately 90%), while for LAD, it improved from 72% to 93% between 2005 and 2015. CONCLUSIONS Despite receiving comparable quality of surgical care, patients with LAD exhibited worse RFS, DSS and OS. © 2017FiguresReferencesRelatedDetailsCited byHautmann R (2018) Declining Use of Orthotopic Reconstruction Worldwide—What Went Wrong?Journal of Urology, VOL. 199, NO. 4, (900-903), Online publication date: 1-Apr-2018. Volume 197Issue 4SApril 2017Page: e252 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Youssef Ahmed More articles by this author Ahmed Hussein More articles by this author Paul May More articles by this author Basel Ahmed More articles by this author Amir Khan More articles by this author John Binkowski More articles by this author Justen Kozlowski More articles by this author Khurshid Guru More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...