PD67-09 COMPARATIVE EFFECTIVNESS OF ROBOT-ASSISTED VS. OPEN RADICAL CYSTECTOMY

Abstract

You have accessJournal of UrologyBladder Cancer: Invasive VII1 Apr 2017PD67-09 COMPARATIVE EFFECTIVNESS OF ROBOT-ASSISTED VS. OPEN RADICAL CYSTECTOMY Nawar Hanna, Jeffrey J. Leow, Maxine Sun, Nicolas von Landenberg, Philipp Gild, Firas Abdollah, Mani Menon, Adam S. Kibel, Joaquim Bellmunt, Toni K. Choueiri, and Quoc-Dien Trinh Nawar HannaNawar Hanna More articles by this author , Jeffrey J. LeowJeffrey J. Leow More articles by this author , Maxine SunMaxine Sun More articles by this author , Nicolas von LandenbergNicolas von Landenberg More articles by this author , Philipp GildPhilipp Gild More articles by this author , Firas AbdollahFiras Abdollah More articles by this author , Mani MenonMani Menon More articles by this author , Adam S. KibelAdam S. Kibel More articles by this author , Joaquim BellmuntJoaquim Bellmunt More articles by this author , Toni K. ChoueiriToni K. Choueiri More articles by this author , and Quoc-Dien TrinhQuoc-Dien Trinh More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.2985AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Over the past decade, robotic-assisted radical cystectomy (RARC) has slowly gained acceptance in the urology community. However, the benefits of RARC over ORC remain controversial. Our objective was to conduct a comparative effectiveness analysis between RARC and ORC using data from the National Cancer Data Base (NCDB). METHODS Within the NCDB, we identified patients with non-metastatic muscle-invasive bladder cancer (BC) who underwent RC between 2010 and 2013. Patients were stratified according to surgical approach: ORC or RARC. Oncologic endpoints measured included the presence of positive surgical margins, the performance of a pelvic lymph node dissection, and number of lymph nodes removed. Perioperative outcomes measured included length of stay (LOS), 30-day and 90-day postoperative mortality rates, as well as 30-day readmission following surgery. To minimize selection bias, observed differences in baseline characteristics between patients who received RARC vs. ORC were controlled for using a weighted propensity score analysis. Using weighted data, all endpoints were assessed using propensity-adjusted logistic regression analyses. RESULTS Of 9,561 patients who underwent RC, 2,048 (21.4%) and 7,513 (78.6%) underwent RARC and ORC, respectively. The use of RARC has increased over time, from 16.7% in 2010 to 25.3% in 2013. With regard to oncologic outcomes, RARC was associated with similar positive surgical margins (9.4% vs. 10.7% OR:0.86, 95%CI 0.72-1.04, p=0.12), higher rates of lymphadenectomy (96.4% vs. 92.0%, OR: 2.31, 95%CI 1.68-3.19, p<0.001), higher median lymph node count (17 vs. 12, p<0.001) and higher rates of lymph node count above the median (56.8% vs. 40.4%, OR: 1.95, 95%CI 1.56-2.43, p<0.001). With regard to postoperative outcomes, receipt of RARC was associated with a shorter median LOS (7 vs. 8, p<0.001), lower rates of pLOS (45.1% vs. 54.8%, OR: 0.68, 95%CI 0.58-0.79, p<0.001), lower 30-day (1.5% vs. 2.8%, OR: 0.49, 95%CI 0.29-0.82, p=0.007) and 90-day postoperative mortality (5.0% vs. 6.8%, OR: 0.72, 95%CI 0.54-0.95, p=0.023). CONCLUSIONS Our large contemporary study shows the increased adoption of RARC between 2010 and 2013, with currently more than 1 out of 4 patients undergoing RARC. RARC was associated with higher LN counts, shorter LOS and lower postoperative mortality. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e1279-e1280 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Nawar Hanna More articles by this author Jeffrey J. Leow More articles by this author Maxine Sun More articles by this author Nicolas von Landenberg More articles by this author Philipp Gild More articles by this author Firas Abdollah More articles by this author Mani Menon More articles by this author Adam S. Kibel More articles by this author Joaquim Bellmunt More articles by this author Toni K. Choueiri More articles by this author Quoc-Dien Trinh More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...