Robotic assisted radical cystectomy: oncological safety

To describe the quality parameters established based on surgical and pathological aspects of bladder carcinoma treatment in the study published by the Bladder Cancer Collaborative Group (BCCG) and compare them against the publications of the International Robotic Cystectomy Consortium (IRCC).

A MEDLINE database search for articles published by BCCG and IRCC and description of them.

Margins: IRCC work globally presented 6.8% of positive margins, a result close to the 6.5% of BCCG. The margins were similar in patients with organ-confined disease (≤ pT2) and those with extravesical disease (pT3-pT4), IRCC work showed a 4.6% positive margin compared to open surgery. In those who had lymph node involvement, negative margins were 6% higher for conventional surgery(BCCG: 14% vs. IRCC: 20%). The impact of learning curve in surgical margins in robotic surgery was not significant. Lymphadenectomy: In BCCG's work, 11% of patients did not have a lymphadenectomy performed, 9% underwent an LL, 67% SL and 13% EL. The mean number of lymph nodes collected was 12.5, with a median of 11. In the IRCC, 82.9% of patients underwent lymphadenectomy (defined as with more than 10 lymph nodes removed), of which 43% had more than 20 nodes removed. The median of the entire series was 17 nodes (range 0-68).

The robotic assisted laparoscopic radical cystectomy (RALRC) is a technique with similar results to conventional surgery in terms of surgical margins and enables the performance of an adequate pelvic lymphadenectomy. Long term results are pending of a longer follow-up of patients operated to date.