Comparing Recurrence Sites in Bladder Cancer After Open Versus Robotic Cystectomy

In the field of bladder cancer research, there are few data on the outcomes of robotic radical cystectomy (RC) with intracorporeal urinary diversion versus an open approach.

Mariaconsiglia Ferriero, MD, PhD, and colleagues carried out a prospective randomized study that compared open cystectomy (ORC) with a robotic (RRC) approach to determine differences between the 2 procedures. Data from the study were presented at the 2024 American Urological Association Annual Meeting,

The 2 approaches were assessed between group differences in terms of site of metastasis. A total of 116 patients underwent ORC or RRC between January 2018 and September 2020. Each patient underwent a covariate adaptive randomization process based on body mass index, American Society of Anesthesiologists score, preoperative hemoglobin, urinary diversion, neoadjuvant chemotherapy, and cT stage.

A log rank test was used to compare 5-year disease-free survival (DFS) rates, metastasis-free survival (MFS), and cancer-specific survival (CSS). Univariable and multivariable regression analyses were used to determine independent predictors of survival. Sites of recurrence were reported and compared between the ORC and RRC groups.

The 5-year DFS, MFS, and CSS rates were 65.0%, 69.5%, and 75.3% in the ORC group versus 73.6%, 78.9%, and 81.5% in the RRC group. At multivariable analysis, pT stage >2 and lymph node density (LNd) were found to be independent predictors of DFS (P<.001 and P=.015 for pT stage >2 and LNd, respectively) and MFS (P<.001 and P=.007 for pT stage >2 and LNd, respectively).

At a median follow-up of 43 months, 44 metastases occurred in 24 patients in the ORC cohort and 20 of those in the RRC cohort. The sites of metastasis included lung, liver, brain, nodes, pancreas, skin, and peritoneum and occurred at similar rates between the ORC and RRC cohorts (P=.15). The incidence of pulmonary (33.3%) and bone (20.8%) metastases was higher in the ORC cohort, while incidence of visceral (25.0%) and peritoneal (15.0%) metastases was higher in the RRC cohort.

ORC and RRC demonstrated comparable oncological outcomes. Site-specific metastasis after robotic or open approaches should be confirmed and monitored to further identify the molecular basis of events.