Abstract
ObjectiveTo perform an external validation of this RC-pentafecta.MethodBetween January 2014 and December 2019, 104 consecutive patients who underwent RARC with ICUD within 6 urological centers were analyzed retrospectively. Patients who simultaneously demonstrated negative soft tissue surgical margins (STSMs), a lymph node (LN) yield ≥ 16, absence of major (Clavien–Dindo grade III–V) 90-day postoperative complications, absence of UD-related long-term sequelae, and absence of 12-month clinical recurrence were considered to have achieved RC-pentafecta. A multivariable logistic regression model was used to measure predictors for achieving RC-pentafecta. We analyzed the influence of this RC-pentafecta on survival, and the impact ofthe surgical experience.ResultsSince 2014, 104 patients who had completed at least 12 months of follow-up were included. Over a mean follow-up of 18 months, a LN yield ≥ 16, negative STSMs, absence of major complications at 90 days, and absence of UD-related surgical sequelae and clinical recurrence at ≤ 12 months were observed in 56%, 96%, 85%, 81%, and 91% of patients, respectively, resulting in a RC-pentafecta rate of 39.4%. Multivariate analysis showed that age was an independent predictor of pentafecta achievement (odds ratio [OR], 0.96; 95% confidence interval [CI], 0.90. 0.99; p = 0.04). The surgeon experience had an impact on the validation of the criteria.ConclusionThis study confirmed that the RC-pentafecta is reproducible and could be externally used for the outcome assessment after RARC with ICUD. Therefore, the RC-pentafecta could be a useful tool to assess surgical success and its impact on different outcomes.
Highlights
Every year, 2.7 million people worldwide are diagnosed or treated for bladder cancer (BCa) [1, 2]
Urinary diversion by ileal conduit was performed in 27.8% of cases (n = 29), and orthotopic neobladder was performed in 72.2% (n = 75) of cases
RC, radical cystectomy; American Society of Anesthesiology (ASA), American society of anesthesiologists; BMI, body mass index; ECOG, Eastern Cooperative Oncology Group; neoadjuvant chemotherapy (NAC), neoadjuvante chemotherapy; EBL, estimated blood loss; UD, urinary diversion; length of hospital stay (LOS), length of stay validation (Table 3)
Summary
2.7 million people worldwide are diagnosed or treated for bladder cancer (BCa) [1, 2]. For locally advanced muscle-invasive bladder cancer (MIBC) without evidence of metastasis, neoadjuvant platinum-based systemic therapy and radical cystectomy (RC) with extensive bilateral pelvic lymph node dissection (PLND) is the recommended first-line curative treatment [3] This procedure is technically demanding and has a complication rate of approximately 25% with a mortality rate of 1–2% regardless of the surgical approach [4]. A RCpentafecta was proposed in 2015 [6]; where the surgical approach of the total cohort was open in 98.7% of cases This RC-pentafecta was modified by Cacciamani et al in 2020 [7] to combine functional and oncological criteria for the evaluation of RARC with intracorporeal urinary diversion (ICUD). These criteria are relevant for assessing the learning curve and the quality of surgery, an external validation remains still required before a wide acceptance and use in future studies
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