Early Oncologic Failure after Robot-assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium

Background We sought to investigate the prevalence and variables associated with Early Oncologic Failure (EOF). Methods Retrospective review of the IRCC database of patients who underwent robot-assisted radical cystectomy (RARC) since 2003. The final cohort comprised 1894 patients (23 institutions from 11 countries). EOF was defined as any disease relapse within 3 months of RARC. All institutions were surveyed for the pneumoperitoneum pressure used, breach of oncological surgical principles and technique of specimen and lymph node removal. Multivariate model was fit to evaluate predictors of EOF. The Kaplan Meier method was used to depict disease-specific (DSS) and overall survival (OS) and Cox proportional regression analysis to evaluate predictors of DSS and OS. Results 305 patients (22%) experienced disease relapse, 220 (16%) distant, 154 (11%) local recurrence, 17 (1%) peritoneal carcinomatosis and 5 (0.4%) port-site recurrences. Seventy-one patients (5%) from 10 institutions developed EOF, and the incidence of EOF decreased from 10% in 2006 to 6% in 2015. On multivariate analysis, presence of any complication (OR 2.87; 95% CI 1.38-5.96; p=0.004), ≥pT3 disease (OR 3.73, 95% CI 2.00-6.97, p<0.001), and nodal involvement (OR 2.14, 95% CI 1.21-3.80, p=0.008) were significant predictors of EOF. Patients with EOF demonstrated worse DSS and OS (23% and 13%) at 1 and 3 years when compared to patients who experienced later or no recurrences (log rank p<0.001) Conclusion The incidence of EOF following RARC has decreased with time. Disease-related rather than technical-related factors play a major role in occurrence of EOF after RARC.