MP32-12 ROBOTIC VERSUS OPEN RADICAL CYSTECTOMY FOR UROTHELIAL CARCINOMA OF THE BLADDER

You have accessJournal of UrologyCME1 Apr 2023MP32-12 ROBOTIC VERSUS OPEN RADICAL CYSTECTOMY FOR UROTHELIAL CARCINOMA OF THE BLADDER Joseph Black, Sumedh Kaul, Aaron Fleishman, Ruslan Korets, Peter Chang, Andrew Wagner, Ma Boston, Simon Kim, Joaquim Bellmunt, Irving Kaplan, Aria Olumi, and Boris Gershman Joseph BlackJoseph Black More articles by this author , Sumedh KaulSumedh Kaul More articles by this author , Aaron FleishmanAaron Fleishman More articles by this author , Ruslan KoretsRuslan Korets More articles by this author , Peter ChangPeter Chang More articles by this author , Andrew WagnerAndrew Wagner More articles by this author , Ma BostonMa Boston More articles by this author , Simon KimSimon Kim More articles by this author , Joaquim BellmuntJoaquim Bellmunt More articles by this author , Irving KaplanIrving Kaplan More articles by this author , Aria OlumiAria Olumi More articles by this author , and Boris GershmanBoris Gershman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003265.12AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The comparative effectiveness of robotic-assisted (RARC) versus open radical cystectomy (ORC) in the management of urothelial carcinoma of the bladder (UCB) remains uncertain. Limited randomized trial evidence suggests similar perioperative outcomes and 2-year progression-free survival, but long-term survival outcomes and real-world data are lacking. We therefore evaluated the comparative effectiveness of RARC and ORC using a nationwide oncology dataset. METHODS: We conducted observational analyses designed to emulate the complete RAZOR trial using the NCDB. Specifically, we identified adults age 37-89 years with Charlson 0-1 diagnosed with cT1-4 cN0-1 cM0 UCB from 2010-2015 and treated with RARC or ORC with LND at a hospital performing an average of >10 RCs per year. We then examined the associations of surgical approach with perioperative outcomes and overall survival (OS) using propensity score methods with stabilized inverse probability of treatment weights (sIPW), with Cox models further adjusted for imbalanced pathologic features (pT and pN stage). RESULTS: A total of 3,493 patients were included in the cohort, of whom 2,492 (71%) underwent ORC and 1001 (29%) underwent RARC. Median follow-up was 29.5 months. After sIPW reweighting, pre-treatment baseline characteristics were well-balanced. After adjustment, RARC was associated with a statistically significant but clinically insignificant higher lymph node (LN) yield (median 20 vs 18 LNs; p<0.01) and shorter length of hospitalization (median 7 [IQR 5-8] vs 7 [IQR 6-10]; p<0.01), but there were no differences in positive surgical margins (8% vs 8%; p=0.64) or 30-day readmissions (10% vs 9%; p=0.80). After adjustment, there was no difference in OS between RARC and ORC (Figure 1; 5-year OS 57% vs 55%; p=0.28; HR 0.93, 95%CI 0.80-1.07). OS treatment effects were similar when examined across cT stage, cN stage, and age. CONCLUSIONS: In observational analyses designed to emulate the complete RAZOR trial, RARC was not associated with statistically significant differences in positive surgical margins, 30-day readmissions, or OS compared to ORC. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e445 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Joseph Black More articles by this author Sumedh Kaul More articles by this author Aaron Fleishman More articles by this author Ruslan Korets More articles by this author Peter Chang More articles by this author Andrew Wagner More articles by this author Ma Boston More articles by this author Simon Kim More articles by this author Joaquim Bellmunt More articles by this author Irving Kaplan More articles by this author Aria Olumi More articles by this author Boris Gershman More articles by this author Expand All Advertisement PDF downloadLoading ...