INTRODUCTION:Critically ill Covid-19 patients are likely to develop the sequence of acute pulmonary hypertension (aPH), right ventricular strain, and eventually right ventricular failure due to currently known pathophysiology (endothelial inflammation plus thrombo-embolism) that promotes increased pulmonary vascular resistance and pulmonary artery pressure. Furthermore, an in-hospital trans-thoracic echocardiography (TTE) diagnosis of aPH is associated with a substantially increased risk of early mortality. The aim of this retrospective observational follow-up study was to explore the mortality during the 1-24-month period following the TTE diagnosis of aPH in the intensive care unit (ICU).METHODS:A previously reported cohort of 67 ICU-treated Covid-19 patients underwent an electronic medical chart-based follow-up 24 months after the ICU TTE. Apart from the influence of aPH versus non-aPH on mortality, several TTE parameters were analyzed by the Kaplan-Meier survival plot technique (K-M). The influence of biomarkers for heart failure (NTproBNP) and myocardial injury (Troponin-T), taken at the time of the ICU TTE investigation, was analyzed using receiver-operator characteristics curve (ROC) analysis.RESULTS:The overall mortality at the 24-month follow-up was 61.5% and 12.8% in group aPH and group non-aPH, respectively. An increased relative mortality risk continued to be present in aPH patients (14.3%) compared to non-aPH patients (5.6%) during the 1-24-month period. The easily determined parameter of a tricuspid valve regurgitation, allowing a measurement of a systolic pulmonary artery pressure (regardless of magnitude), was associated with a similar K-M outcome as the generally accepted diagnostic criteria for aPH (systolic pulmonary artery pressure >35 mmHg). The biomarker values of NTproBNP and Troponin-T at the time of the TTE did not result in any clinically useful ROC analysis data.CONCLUSION:The mortality risk was increased up to 24 months after the initial examination in ICU-treated Covid-19 patients with a TTE diagnosis of aPH, compared to non-aPH patients. Certain individual TTE parameters were able to discriminate 24-month risk of morality.

INTRODUCTION:Critically ill Covid-19 pneumonia patients are likely to develop the sequence of acute pulmonary hypertension, right ventricular (RV) strain, and eventually RV failure due to known pathophysiology (endothelial inflammation plus thrombo-embolism) that promotes increased pulmonary vascular resistance and pulmonary artery pressure. This study aimed to investigate the occurrence of acute pulmonary hypertension (aPH) as per established trans-thoracic echocardiography (TTE) criteria in Covid-19 patients receiving intensive care and to explore whether short-term outcomes are affected by the presence of aPH.METHODS:Medical records were reviewed for patients treated in the intensive care units at a tertiary university hospital over a month. The presence of aPH on the TTE was noted, and plasma NTproBNP and troponin were measured as markers of cardiac failure and myocardial injury, respectively. Follow-up data were collected 21 d after the performance of TTE.RESULTS:In total, 26 of 67 patients (39%) had an assessed systolic pulmonary artery pressure of > 35 mmHg (group aPH), meeting the TTE definition of aPH. NTproBNP levels (median [range]: 1430 [102-30 300] vs. 470 [45-29 600] ng L-1 ; P = .0007), troponin T levels (63 [22-352] vs. 15 [5-407] ng L-1 ; P = .0002), and the 21-d mortality rate (46% vs. 7%; P < .001) were substantially higher in patients with aPH compared to patients not meeting aPH criteria.CONCLUSION:TTE-defined acute pulmonary hypertension was frequently observed in severely ill Covid-19 patients. Furthermore, aPH was linked to biomarker-defined myocardial injury and cardiac failure, as well as an almost sevenfold increase in 21-d mortality.

ObjectiveTo report a single‐institution experience with totally intracorporeal neobladder urinary diversion (UD) after robot‐assisted laparoscopic radical cystectomy (RARC).Patients and methodsA total of 158 patients underwent totally intracorporeal neobladder UD after RARC between 2003 and 2016. Patient demographics, intraoperative and pathological data, 30‐ and 90‐day perioperative mortality and complications were recorded. Complications were classified according to the modified Clavien–Dindo classification. The 5‐year overall (OS) and cancer‐specific survival (CSS) rates were estimated by Kaplan–Meier plots.ResultsMost of the patients were male (84%) and had clinical T Stage ≤2 (87%). The mean operation time was 359 (SD ±98) min, with a median (range) estimated blood loss of 300 (50–2200) mL. Most of the men (86%) received a nerve‐sparing procedure and 38% of the females an organ‐sparing approach. A lymph node dissection was performed in 156 (99%) patients, with a median (range) yield of 23 (7–48) nodes. Conversion to open surgery occurred in five patients (3%). We recorded negative margins in 156 patients (99%). The median (range) follow‐up was 34 (1–170) months, with 30‐ and 90‐day mortality rates of 0%. Clavien–Dindo Grade III–IV complications occurred in 29 of 158 (18%) patients at 30‐days and in eight of 158 (5%) between 30–90 days, resulting into a 90‐day overall high‐grade complication rate of 23%. The unadjusted estimated 5‐years recurrence‐free survival, CSS and OS rates were 70%, 72%, and 71%, respectively.ConclusionIn our present series the complication and oncological results were similar to open RC series, suggesting that RARC followed by totally intracorporeal neobladder UD is a safe and feasible alternative.

A posterior reconstruction (PR) might improve the fluidity and delicacy of the maneuvers related to the neovesico-urethral anastomosis during robotic-assisted radical cystectomy (RARC). Our objective is to describe in detail the surgical steps of PR and to assess its feasibility and functional outcomes. The data regarding patients undergoing a totally intracorporeal RARC with neobladder and PR for high-grade and/or muscle-invasive urothelial cancer of the bladder at Karolinska University Hospital between October 2015 and November 2016 by a single surgeon (PW) were reviewed. Prior to the anastomosis, a modified posterior Rocco’s repair involving the Denonvillier’s fascia, the rhabdosphincter, and the posterior side of the ileal neobladder neck was performed. The steps are shown in a video at https://doi.org/10.1089/vid.2019.0029 . The primary outcome was urinary continence; the secondary outcomes were urinary leakage, intermittent catheterization, and complications related to the reconstructive steps. Eleven male patients with a median age and BMI of 67 years and 24, respectively, underwent RARC with PR associated to the neovesico-urethral anastomosis. Overall and posterior reconstruction time were 300′ (195–320) and 6′ (4–7), respectively. The daytime and nighttime continence rates were 100% and 44% at 12 months, respectively; the median pad weight was 3.5 g and 108 g at daytime and nighttime, respectively. One urinary leakage from the urethrovesical anastomosis was treated conservatively. Two patients perform intermittent catheterization. The posterior reconstruction during RARC is safe and feasible, providing good continence rates. It supported a careful suturing of the anastomosis as well as an uncomplicated catheter placement.

Introduction: To assess the feasibility and functional outcomes of posterior reconstruction (PR) during robot-assisted radical cystectomy (RARC) with neobladder.Materials and Methods: The data regarding patients undergoing a totally intracorporeal RARC with neobladder and PR for urothelial bladder cancer at Karolinska University Hospital between October 2015 and November 2016 by a single surgeon (P.W.) were reviewed.All patients received a PR associated with the neovesicourethral anastomosis during RARC.A running suture involving the Denonvillier's fascia, the rhabdosphincter, and the posterior side of the ileal neobladder neck is performed before the anastomosis.The primary outcome was urinary continence, defined as no leakage or use of a safety pad for minimal leakage during daytime and nighttime.The secondary outcomes were urinary leakage, intermittent catheterization, and complications directly related to the reconstructive steps.

Nephron-sparing surgery (NSS) remains gold standard for the treatment of localised renal cell cancer (RCC), even in case of a normal contralateral kidney. Compared to radical nephrectomy, kidney failure and cardiovascular events are less frequent with NSS. However, the effects of different surgical approaches and of zero ischaemia on the postoperative reduction in renal function remain controversial. We aimed to investigate the relative short- and long-term changes in estimated glomerular filtration rate (eGFR) after ischaemic or zero-ischaemic open (ONSS) and laparoscopic NSS (LNSS) for RCC, and to analyse prognostic factors for postoperative acute kidney injury (AKI) and chronic kidney disease (CKD) stage ≥3. Data of 444 patients (211 LNSS, 233 ONSS), including 57 zero-ischaemic cases, were retrospectively analysed. Multiple regression models were used to predict relative changes in renal function. Natural cubic splines were used to demonstrate the association between ischaemia time (IT) and relative changes in renal function. IT was identified as significant risk factor for short-term relative changes in eGFR (ß = − 0.27) and development of AKI (OR, 1.02), but no effect was found on long-term relative changes in eGFR. Natural cubic splines revealed that IT had a greater effect on patients with baseline eGFR categories ≥G3 concerning short-term decrease in renal function and development of AKI. Unlike LNSS, ONSS was significantly associated with short-term decrease in renal function (ß = − 13.48) and development of AKI (OR, 3.87). Tumour diameter was associated with long-term decrease in renal function (ß = − 1.76), whereas baseline eGFR was a prognostic factor for both short- (ß = − 0.20) and long-term (ß = − 0.29) relative changes in eGFR and the development of CKD stage ≥3 (OR, 0.89). IT is a significant risk factor for AKI. The short-term effect of IT is not always linear, and the impact also depends on baseline eGFR. Unlike LNSS, ONSS is associated with the development of AKI. Our findings are helpful for surgical planning, and suggest either the application of a clampless NSS technique or at least the shortest possible IT to reduce the risk of short-time impairment of the renal function, which might prevent AKI, particularly regarding patients with baseline eGFR category ≥G3.

Incidental Prostate cancer (iPCa) is a relatively common finding during histopathological evaluation of radical cystectomy (RC) specimens. To reduce the high impact of RC on erectile function, several sexual-preserving techniques have been proposed. The aim of this study was to evaluate and compare the oncologic outcomes of patients with iPCa who underwent nerve spring and no-nerve sparing robot-assisted radical cystectomy (RARC). The clinicopathologic data of male patients who underwent RARC at our institution between 2006 and 2016 were retrospectively analysed. Patients with iPCa at definitive pathological examinations were stratified in two groups, according to the preservation of the neurovascular bundles (nerve sparing vs no nerve sparing). Significant PCa was defined as any Gleason score ≥ 3 + 4. Biochemical recurrence (BR) was defined as a sustained PSA level > 0.2 ng/mL on two or more consecutive appraisals. BR rate was assessed only in patients with incidental prostate cancer and at least 2 years of follow-up. Differences in categorical and continuous variables were analysed using the chi-squared test and the Mann–Withney U test, respectively. Biochemical recurrence curves were generated using the Kaplan–Meier method and compared with the Log-rank test. Overall, 343 male patients underwent RARC for bladder cancer within the study period. Nerve-sparing surgery was performed in 143 patients (41%), of these 110 had at least 2 years of follow up after surgery. Patients who underwent nerve-sparing surgery were significantly younger (p < 0.001). Clinically significant PCa was found in 24% of patients. No significant differences regarding preoperative PSA value (p = 0.3), PCa pathological stage (p = 0.5), Gleason score (p = 0.3) and positive surgical margin rates (p = 0.3) were found between the two groups. After a median follow-up of 51 months only one patient, in the no-nerve-sparing group had developed a biochemical recurrence (p = 0.4). In our series most of the iPca detected in RC specimens can be considered as insignificant with a low rate of BR (0.9%). Nerve-sparing RARC is a safe procedure which did not affect oncological outcomes of patients with iPCa.

Background: It is unclear whether preoperative staging using Magnetic Resonance Imaging (MRI) reduces the risk of positive margins in prostate cancer. We aimed to assess the effect on surgical margins and degree of nerve sparing of a pelvic MRI presented at a preoperative MRI conference. Methods: Single institution, observational cohort study including 1037 men that underwent robot assisted radical prostatectomy between October 2013 and June 2015. Of these, 557 underwent a preoperative MRI combined with a preoperative MRI conference and 410 did not. With whole-mount prostate specimen histopathology as gold standard we assessed the ability of MRI in finding the index tumor and the sensitivity and specificity for extra prostatic extension. We calculated relative risks for positive surgical margins and non-nerve sparing procedure, adjusting for preoperative risk factors using stabilized inverse-probability weighting. Results: MRI detected the index tumor in 80% of the cases. Non-organ confined disease (pT3) at histology was present in the MRI and the non-MRI group in 42% and 24%, respectively. Rate of positive surgical margins comparing the MRI and non-MRI groups was 26.7% and 33.7%, respectively, relative risk 0.79 [95% CI 0.65–0.96], weighted relative risk (wRR) 0.69 [95% CI 0.55–0.86]. The wRR of extensive positive surgical margins was 0.45 [95% CI 0.31–0.67]. Undergoing MRI was also associated with an increased risk of being operated with a non-nerve sparing technique (wRR, 1.84 [95% CI 1.11–3.03]). Conclusions: Our study suggests that preoperative prostate MRI in combination with a preoperative MRI conference affects the degree of nerve-sparing surgery and reduces positive surgical margins.

To describe the evolution in radical cystectomy (RC) care over 11 years at a referral centre. The clinical data of patients undergoing either open RC (ORC) or robot-assisted RC (RARC) for cT1-4aN0M0 bladder cancer (BCa) at our centre between January 2006 and December 2016 were retrospectively evaluated. Crude and propensity score-weighted log-binomial regression analyses were conducted to assess the association between pre- and peri-operative variables and the risk of reoperation, intensive care unit (ICU) admission and death <90 days after RC. A total of 814 patients were considered. The percentage of RARCs performed increased (from 10% to 100%) between 2006 and 2013. Overall, 29% of the patients received neoadjuvant chemotherapy (12–37% from 2006 to 2016). Despite no differences in terms of operating time, pelvic lymph node dissection (PLND) was more commonly attempted during RARC and extended PLND was more frequently performed in the RARC group (72% vs 19%; P < 0.001). Ileal conduit was the preferred urinary diversion in both groups, and more patients in the RARC group underwent neobladder construction (34% vs 14%; P < 0.001). The overall rates of re-intervention, ICU admission and death within 90 days of RC were 8.9%, 5.4% and 2.9%, respectively. On crude analysis, RARC was associated with a reduced risk of ICU admission (relative risk [RR] 0.42, 95% confidence interval [CI] 0.23–0.77; P = 0.005), reintervention (RR 0.58, 95% CI 0.37–0.90; P = 0.015) and death (RR 0.37, 95% CI 0.16–0.85; P = 0.020); however, these risk reductions were not statistically significant on weighted analyses. The introduction of RARC has coincided with a reduction in the rate of ICU admission, reoperation and death within 90 days of surgery, without compromising operating time, PLND extent or neobladder utilization.

You have accessJournal of UrologyBladder Cancer: Invasive II1 Apr 2017MP34-15 A EUROPEAN MULTI-CENTRE REPORT ON CURRENT NEOADJUVANT CHEMOTHERAPY ADMINISTRATION RATES IN ROBOT-ASSISTED RADICAL CYSTECTOMY PATIENTS AND THE IMPACT ON PATHOLOGICAL STAGING Justin Collins, Abolfazl Hosseini, Christofer Adding, Anthony Koupparis, Edward Rowe, Matthew Perry, Rami Issa, Tommy Nyberg, Martin Schumacher, Carl Wijburg, A. Erdem Canda, Mevlana Balbay, Karel Decaestecker, Christian Schwentner, Arnulf Stenzl, Sebastian Edeling, Sasa Pokupik, Ferderiek D'Hondt, Alexandre Mottrie, and Peter Wiklund Justin CollinsJustin Collins More articles by this author , Abolfazl HosseiniAbolfazl Hosseini More articles by this author , Christofer AddingChristofer Adding More articles by this author , Anthony KoupparisAnthony Koupparis More articles by this author , Edward RoweEdward Rowe More articles by this author , Matthew PerryMatthew Perry More articles by this author , Rami IssaRami Issa More articles by this author , Tommy NybergTommy Nyberg More articles by this author , Martin SchumacherMartin Schumacher More articles by this author , Carl WijburgCarl Wijburg More articles by this author , A. Erdem CandaA. Erdem Canda More articles by this author , Mevlana BalbayMevlana Balbay More articles by this author , Karel DecaesteckerKarel Decaestecker More articles by this author , Christian SchwentnerChristian Schwentner More articles by this author , Arnulf StenzlArnulf Stenzl More articles by this author , Sebastian EdelingSebastian Edeling More articles by this author , Sasa PokupikSasa Pokupik More articles by this author , Ferderiek D'HondtFerderiek D'Hondt More articles by this author , Alexandre MottrieAlexandre Mottrie More articles by this author , and Peter WiklundPeter Wiklund More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1032AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Neoadjuvant chemotherapy is considered the standard of care in patients with muscle-invasive bladder cancer (MIBC) and has been shown to confer overall survival advantages of 5% in RCTs. Data on neoadjuvant chemotherapy (NAC) administration rates in patients undergoing robot-assisted radical cystectomy (RARC) is limited, ranging from 0 to 31% in the published literature. We report administration rates of NAC from a multi-institutional European database focusing on the centres performing totally intracorporeal RARC. Reporting the effect of NAC on down-staging and up-staging rates from clinical staging (cT) to the pathological specimen (pT). METHODS Retrospective review of the prospectively populated multi-institutional database identified 717 patients at 9 different Institutions (6 countries), with a minimum of 12 months follow-up, who underwent RARC for non-metastatic bladder cancer with curative intent between Dec 2003 and March 2015. Clinical stage was assigned based on a combination of specimen pathology from TURBT, EUA and imaging studies. Cisplatin based NAC was offered to patients with cT2-cT4, taking into account patient performance status. Clinical staging, pathologic staging and survival data at the latest follow-up were collected. RESULTS Median age was 68 years, 78% were men. 95.2% of patients had TCC. 532 (74.2%) patients were alive at the time of the analysis. The median follow-up time for patients was 31 months (IQR 20-46). 465 patients (65%) had cT2-T4 TCC. In this series 25.3% of patients received NAC. See table 1 for upstaging and down-staging related to NAC. PSM rates were associated with upstaging (p<0.001). On multivariable analysis NAC was associated with down-staging in all patients OR 3.46 95% CI 2.34-5.13 p <0.001 and this effect increased in patients with non-organ confined disease OR 5.45 95%CI 2.15-13.8 p<0.001. The 5-year CSS, OS and RFS were 69.9%, 66.1% and 66.3% respectively. On multivariable analysis, pathological non-organ confined versus organ confined disease was found to impact CSS, OS and RFS (HR 4.4, 3.8 and 3.8 respectively). CONCLUSIONS NAC was associated with downstaging of MIBC. Increasing NAC administration rates would likely further improve oncological outcomes. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e432-e433 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Justin Collins More articles by this author Abolfazl Hosseini More articles by this author Christofer Adding More articles by this author Anthony Koupparis More articles by this author Edward Rowe More articles by this author Matthew Perry More articles by this author Rami Issa More articles by this author Tommy Nyberg More articles by this author Martin Schumacher More articles by this author Carl Wijburg More articles by this author A. Erdem Canda More articles by this author Mevlana Balbay More articles by this author Karel Decaestecker More articles by this author Christian Schwentner More articles by this author Arnulf Stenzl More articles by this author Sebastian Edeling More articles by this author Sasa Pokupik More articles by this author Ferderiek D'Hondt More articles by this author Alexandre Mottrie More articles by this author Peter Wiklund More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV1 Apr 2017MP59-19 OUTCOME OF KIDNEY FUNCTION AFTER ISCHAEMIC AND ZERO-ISCHAEMIC LAPAROSCOPIC AND OPEN NEPHRON-SPARING SURGERY FOR RCC Jan Ebbing, Kurt Miller, Frank Friedersdorff, Florian Fuller, Jonas Busch, Hans H. Seifert, Peter Ardelt, Christian Wetterauer, Justin Collins, Christofer Adding, Paolo Frumento, and Carsten Kempkensteffen Jan EbbingJan Ebbing More articles by this author , Kurt MillerKurt Miller More articles by this author , Frank FriedersdorffFrank Friedersdorff More articles by this author , Florian FullerFlorian Fuller More articles by this author , Jonas BuschJonas Busch More articles by this author , Hans H. SeifertHans H. Seifert More articles by this author , Peter ArdeltPeter Ardelt More articles by this author , Christian WetterauerChristian Wetterauer More articles by this author , Justin CollinsJustin Collins More articles by this author , Christofer AddingChristofer Adding More articles by this author , Paolo FrumentoPaolo Frumento More articles by this author , and Carsten KempkensteffenCarsten Kempkensteffen More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2017.02.1835AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Kidney failure is less frequently seen in nephron-sparing surgery (NSS) for renal tumours compared to radical nephrectomy. Thus, reduction of the renal function (RF) is seen in NSS patients mainly related to nephron tissue removal, renal ischaemia and a reduced baseline RF. Therefore, it remains controversial whether open NSS (ONSS) and laparoscopic NSS (LNSS) have different effects on the postoperative (p.o.) RF and whether zero-ischaemia (ZI) has a protective effect on the RF. METHODS Between 1999 and 2010 a total of 444 cases (211 LNSS, 233 ONSS) including 57 ZI cases with RCC were retrospectively included into this study. The GFR (glomerular fitration rate) was estimated before surgery and for various p.o. measurements: (A) lowest value during the first 48h p.o. and (B) during the planned hospital stay prior to discharge (day 4 (2-6)), (C) an average 47 (30-105) days, (D) 13 (12-15) months, and (E) 44 (33-76) months (last follow-up) p.o. We used multiple regression models to predict the relative change of the eGFR from baseline at time B (model 1) and at time D (model 2), and to identify predictors of acute kidney injury (AKI) within 48h p.o. (model 3) and a decreased eGFR <60ml/min/1.73m2 at time D (model 4). A spline function was used to estimate the correlation between the ischaemia time (IT) and the relative change of the eGFR at time B in model 1 and at time D in model 2 and the correlation between the IT and the probability of AKI in model 3 and its interaction with the baseline RF, respectively. Continuous data are shown as median values with IQR. RESULTS Postoperatively 38.5% of the patients developed AKI and 28.9% developed an eGFR <60ml/min/1.73m2 at time D. Fig. 1.1 and 1.2 show the plot of the spline function in model 1 and 2. Fig. 1.3 shows the probability of AKI in model 3. On regressional analysis in model 1 baseline eGFR (beta (b) -0.20), ONSS (b -13.49), BMI (b -0.88), IT (b -0.27), major complications (b -10.97), and the operation time (b -0.06), and in model 2 baseline eGFR (b -0.32), the Charlson score (b 1.80), and the tumour diameter (b -1.57) were all significant factors for changes in eGFR. Predictors for AKI (model 3) was ONSS (OR 4.1), male gender (OR 2.55), Charlson score (OR 1.22), BMI (OR 1.13), IT (OR 1.02), and the operation time (OR 1.008). The only significant predictor for model 4 was the baseline eGFR (OR 0.90). CONCLUSIONS IT influences the short-term change in RF. The development of AKI is not always linear and the impact of ischaemia is also dependent on the baseline RF. ZI surgery was not shown to influence the outcome variables significantly. ONSS was identified to be a risk factor for impairement of the RF and the developemnt of AKI compared to LNSS. Additional factors influencing the RF at 13 months p.o. was the baseline eGFR and the tumour diameter as a surrogate for volume of parenchyma removed during NSS. © 2017FiguresReferencesRelatedDetails Volume 197Issue 4SApril 2017Page: e788-e789 Advertisement Copyright & Permissions© 2017MetricsAuthor Information Jan Ebbing More articles by this author Kurt Miller More articles by this author Frank Friedersdorff More articles by this author Florian Fuller More articles by this author Jonas Busch More articles by this author Hans H. Seifert More articles by this author Peter Ardelt More articles by this author Christian Wetterauer More articles by this author Justin Collins More articles by this author Christofer Adding More articles by this author Paolo Frumento More articles by this author Carsten Kempkensteffen More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

OBJECTIVES:To describe the evolution in radical cystectomy (RC) care over 11 years at a referral centre.PATIENTS AND METHODS:The clinical data of patients undergoing either open RC (ORC) or robot-assisted RC (RARC) for cT1-4aN0M0 bladder cancer (BCa) at our centre between January 2006 and December 2016 were retrospectively evaluated. Crude and propensity score-weighted log-binomial regression analyses were conducted to assess the association between pre- and peri-operative variables and the risk of reoperation, intensive care unit (ICU) admission and death <90 days after RC.RESULTS:A total of 814 patients were considered. The percentage of RARCs performed increased (from 10% to 100%) between 2006 and 2013. Overall, 29% of the patients received neoadjuvant chemotherapy (12-37% from 2006 to 2016). Despite no differences in terms of operating time, pelvic lymph node dissection (PLND) was more commonly attempted during RARC and extended PLND was more frequently performed in the RARC group (72% vs 19%; P < 0.001). Ileal conduit was the preferred urinary diversion in both groups, and more patients in the RARC group underwent neobladder construction (34% vs 14%; P < 0.001). The overall rates of re-intervention, ICU admission and death within 90 days of RC were 8.9%, 5.4% and 2.9%, respectively. On crude analysis, RARC was associated with a reduced risk of ICU admission (relative risk [RR] 0.42, 95% confidence interval [CI] 0.23-0.77; P = 0.005), reintervention (RR 0.58, 95% CI 0.37-0.90; P = 0.015) and death (RR 0.37, 95% CI 0.16-0.85; P = 0.020); however, these risk reductions were not statistically significant on weighted analyses.CONCLUSIONS:The introduction of RARC has coincided with a reduction in the rate of ICU admission, reoperation and death within 90 days of surgery, without compromising operating time, PLND extent or neobladder utilization.

BACKGROUND:Robot-assisted radical prostatectomy (RARP) for prostate cancer (PCa) treatment has been widely adopted with limited evidence for long-term (>5 yr) oncologic efficacy.OBJECTIVE:To evaluate long-term oncologic outcomes following RARP.DESIGN, SETTING, AND PARTICIPANTS:Prospective cohort study of 885 patients who underwent RARP as monotherapy for PCa between 2002 and 2006 in a single European centre and followed up until 2016.INTERVENTION:RARP as monotherapy.OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS:Biochemical recurrence (BCR)-free survival (BCRFS), salvage therapy (ST)-free survival (STFS), prostate cancer-specific survival (CSS), and overall survival (OS) were estimated using the Kaplan-Meier method, and event-time distributions were compared using the log-rank test. Variables predictive of BCR and ST were identified using Cox proportional hazards models.RESULTS AND LIMITATIONS:We identified 167 BCRs, 110 STs, 16 PCa-related deaths, and 51 deaths from other/unknown causes. BCRFS, STFS, CSS, and OS rates were 81.8%, 87.5%, 98.5%, and 93.0%, respectively, at median follow-up of 10.5 yr. On multivariable analysis, the strongest independent predictors of both BCR and ST were preoperative Gleason score, pathological T stage, positive surgical margins (PSMs), and preoperative prostate-specific antigen. PSM >3mm/multifocal but not ≤3mm independently affected the risk of both BCR and ST. Study limitations include a lack of centralised histopathologic reporting, lymph node and post-operative tumour volume data in a historical cohort, and patient-reported outcomes.CONCLUSIONS:RARP appears to confer effective long-term oncologic efficacy. The risk of BCR or ST is unaffected by ≤3mm PSM, but further follow-up is required to determine any impact on CSS.PATIENT SUMMARY:Robot-assisted surgery for prostate cancer is effective 10 yr after treatment. Very small (<3mm) amounts of cancer at the cut edge of the prostate do not appear to impact on recurrence risk and the need for additional treatment, but it is not yet known whether this affects the risk of death from prostate cancer.

You have accessJournal of UrologyBladder Cancer: Invasive VI1 Apr 2016PD39-05 ONCOLOGICAL OUTCOMES OF TOTALLY INTRACORPOREAL ROBOT-ASSISTED RADICAL CYSTECTOMY: RESULTS FROM THE EUROPEAN ASSOCIATION OF UROLOGY ROBOTIC UROLOGY SECTION (ERUS) SCIENTIFIC WORKING GROUP Abolfazl Hosseini, Justin Collins, Christofer Adding, Tommy Nyberg, Anthony Koupparis, Edward Rowe, Matthew Perry, Rami Issa, Martin Schumacher, Carl Wijburg, Erdem Canda, Mevlana Balbay, Karel Decaestecker, Christian Schwentner, Arnulf Stenzl, Sebastian Edeling, Saša Pokupic, Khurshid Guru, Alexander Mottrie, and Peter Wiklund Abolfazl HosseiniAbolfazl Hosseini More articles by this author , Justin CollinsJustin Collins More articles by this author , Christofer AddingChristofer Adding More articles by this author , Tommy NybergTommy Nyberg More articles by this author , Anthony KoupparisAnthony Koupparis More articles by this author , Edward RoweEdward Rowe More articles by this author , Matthew PerryMatthew Perry More articles by this author , Rami IssaRami Issa More articles by this author , Martin SchumacherMartin Schumacher More articles by this author , Carl WijburgCarl Wijburg More articles by this author , Erdem CandaErdem Canda More articles by this author , Mevlana BalbayMevlana Balbay More articles by this author , Karel DecaesteckerKarel Decaestecker More articles by this author , Christian SchwentnerChristian Schwentner More articles by this author , Arnulf StenzlArnulf Stenzl More articles by this author , Sebastian EdelingSebastian Edeling More articles by this author , Saša PokupicSaša Pokupic More articles by this author , Khurshid GuruKhurshid Guru More articles by this author , Alexander MottrieAlexander Mottrie More articles by this author , and Peter WiklundPeter Wiklund More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1511AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Data on the oncological outcomes in patients undergoing robot-assisted radical cystectomy (RARC) is limited. Globally extracorporeal urinary diversion following RARC remains the most common approach despite potential advantages of a completely minimally invasive approach. We report oncological outcomes and associated prognostic factors from a multi-institutional European database focusing on the centres performing totally intracorporeal RARC. METHODS Retrospective review of the prospectively populated ERUS scientific working group multi-institutional database identified 621 patients at 10 different Institutions (7 countries), with a minimum of 3 months follow-up, who underwent RARC with an intracorporeal urinary diversion between December 2003 and January 2015. Clinical, pathologic, and survival data at the latest follow-up were collected. RESULTS Median age was 66 years, 83% were men. 95% of patients had transitional cell carcinoma. 112 (76%) patients were alive at the time of the analysis. 24% received neoadjuvant chemotherapy. The median follow-up time for patients was 19 months (IQR 11-36). 147 patients had a minimum of 3 years follow-up and 47 patients (32%) had undergone surgery 5 or more years ago. 30 patients (4.85%) had a positive surgical margin (PSM), of which 28 (93.3%) had T3/T4 disease, equivalent to 13.9% of all patients with T3/T4. Two patients (0.7%) with organ-confined disease had a PSM. The median yield for extended pelvic lymph node dissection was 18. The 5-year cancer specific survival (CSS), overall survival (OS) and recurrence free survival (RFS) were 73.8%, 70.5% and 71.6% respectively. On multivariable analysis, non-organ confined versus organ confined disease was found to impact CSS, OS and RFS (HR 4.5, 3.3 and 4.2 respectively). In this series no patient with pT0 has had a recurrence to date. CONCLUSIONS Medium term follow-up for totally intracorporeal RARC shows acceptable survival outcomes comparable to open radical cystectomy series. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e931-e932 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Abolfazl Hosseini More articles by this author Justin Collins More articles by this author Christofer Adding More articles by this author Tommy Nyberg More articles by this author Anthony Koupparis More articles by this author Edward Rowe More articles by this author Matthew Perry More articles by this author Rami Issa More articles by this author Martin Schumacher More articles by this author Carl Wijburg More articles by this author Erdem Canda More articles by this author Mevlana Balbay More articles by this author Karel Decaestecker More articles by this author Christian Schwentner More articles by this author Arnulf Stenzl More articles by this author Sebastian Edeling More articles by this author Saša Pokupic More articles by this author Khurshid Guru More articles by this author Alexander Mottrie More articles by this author Peter Wiklund More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...