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British Journal of Urology
Article . 2020 . Peer-reviewed
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Oncological outcome according to attainment of pentafecta after robot‐assisted radical cystectomy in patients with bladder cancer included in the multicentre KORARC database

Authors: Sangchul Lee; Jong Kil Nam; Koon Ho Rha; Woong Kyu Han; Sang Hyup Lee; Seung Hyun Jeon; Seok Ho Kang; +16 Authors

Oncological outcome according to attainment of pentafecta after robot‐assisted radical cystectomy in patients with bladder cancer included in the multicentre KORARC database

Abstract

ObjectivesTo investigate the oncological significance of a robot‐assisted radical cystectomy (RARC)‐related pentafecta in patients with bladder cancer.Patients and MethodsUsing the KORARC database, which includes data from 12 centres, data from 730 patients who underwent RARC between April 2007 and May 2019 were prospectively collected and retrospectively analysed. Pentafecta was achieved if patients met all of the following criteria: (i) negative soft tissue surgical margin; (ii) ≥16 lymph nodes removed; (iii) no major complications (Clavien–Dindo grade 3–5) within 90 days; (iv) no clinical recurrence within the first 12 months; and (v) no ureteroenteric stricture. Patients were divided into two groups according to pentafecta attainment, and a comparison of overall survival (OS) and cancer‐specific survival (CSS) using multivariate Cox proportional analysis was then carried out.ResultsOf the 730 patients included in this analysis, 208 (28.5%) attained the RARC pentafecta; the remaining 522 (71.5%) did not. The mean age of the patients was 64.67 years, 85.1% were men, 53.6% received a conduit, 37.7% received orthotopic neobladders and the total complication rate was 57.8%. Those who attained the pentafecta received more neobladders (P = 0.039), were more likely to be treated with the intracorporeal technique (P < 0.001), had longer operating times (P = 0.020) and had longer console time (P = 0.021) compared with those who did not attain the pentafecta. Over a mean of 31.1 months of follow‐up, the pentafecta attainment group had significantly higher OS and CSS rates compared with the non‐attainment group (10‐year OS 70.4% vs 58.1%, respectively [P = 0.016]; 10‐year CSS 87.8% vs 70.0%, respectively [P = 0.036]). Multivariate analysis showed that the RARC pentafecta was a significant predictor of overall mortality (hazard ratio 0.561; P = 0.038).ConclusionsPatients who attained the RARC pentafecta had significantly better survival outcomes compared with those who did not. These criteria could be used to standardize assessment of the surgical quality of RARC. In the future, a similar study using an independent cohort is warranted to confirm our results.

Keywords

Robotic Surgical Procedures / methods*, Male, uroonc, Databases, Factual, Urinary Bladder Neoplasms / surgery*, Operative Time, Urinary Bladder, 610, Urinary Bladder / surgery*, Cystectomy, survival, Cystectomy / methods*, Disease-Free Survival, blcsm, Databases, Neoplasm Staging / methods, Postoperative Complications, Robotic Surgical Procedures, Risk Factors, Republic of Korea, Postoperative Complications / epidemiology*, Humans, Factual, Republic of Korea / epidemiology, Neoplasm Staging, Retrospective Studies, Urinary Bladder / diagnostic imaging, Incidence, Middle Aged, Prognosis, Bladder Cancer, robot cystectomy, Survival Rate, Survival Rate / trends, Urinary Bladder Neoplasms, Urinary Bladder Neoplasms / mortality, Urinary Bladder Neoplasms / diagnosis, Female, Follow-Up Studies

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    This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
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selected citations
These citations are derived from selected sources.
This is an alternative to the "Influence" indicator, which also reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Citations provided by BIP!
popularity
This indicator reflects the "current" impact/attention (the "hype") of an article in the research community at large, based on the underlying citation network.
BIP!Popularity provided by BIP!
influence
This indicator reflects the overall/total impact of an article in the research community at large, based on the underlying citation network (diachronically).
BIP!Influence provided by BIP!
impulse
This indicator reflects the initial momentum of an article directly after its publication, based on the underlying citation network.
BIP!Impulse provided by BIP!
18
Top 10%
Top 10%
Top 10%
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