Surgical Margin Status After Robot Assisted Radical Cystectomy: Results From the International Robotic Cystectomy Consortium

Received 2 December 2009 published online 17 May 2010.

Purpose

Positive surgical margins at radical cystectomy confer a poor prognosis. We evaluated the incidence and predictors of positive surgical margins in patients who underwent robot assisted radical cystectomy for bladder cancer.

Materials and Methods

Using the International Robotic Cystectomy Consortium database we identified 513 patients who underwent robot assisted radical cystectomy, as done by a total of 22 surgeons at 15 institutions from 2003 to 2009. After stratification by age group, gender, pathological T stage, nodal status, sequential case number and institutional volume logistic regression was used to correlate variables with the likelihood of a positive surgical margin.

Results

Of the 513 patients 35 (6.8%) had a positive surgical margin. Increasing 10-year age group, lymph node positivity and higher pathological T stage were significantly associated with an increased likelihood of a positive margin (p = 0.010, <0.001 and p <0.001, respectively). Gender, sequential case number and institutional volume were not significantly associated with margin positivity. The rate of margin positive disease at cystectomy was 1.5% for pT2 or less, 8.8% for pT3 and 39% for pT4 disease.

Conclusions

Positive surgical margin rates at robot assisted radical cystectomy for advanced bladder cancer were similar to those in open cystectomy series in a large, multi-institutional, prospective cohort. Sequential case number, a surrogate for the learning curve and institutional volume were not significantly associated with positive margins at robot assisted radical cystectomy.

Key Words: urinary bladder, cystectomy, robotics, carcinoma, urothelium

Abbreviations and Acronyms: IRCC, International Robotic Cystectomy Consortium, RARC, robot assisted RC, RC, radical cystectomy

a Department of Urologic Oncology, Roswell Park Cancer Institute, Buffalo, New York

b Department of Urologic Oncology, Mayo Clinic, Scottsdale, Arizona

c Department of Urologic Oncology, Onze-Lieve-Vrouw Ziekenhuis, Aalst, Belgium

d Department of Urologic Oncology, Guy's Hospital, London, United Kingdom

e Department of Urologic Oncology, Tulane University, New Orleans, Louisiana

f Department of Urologic Oncology, Washington University, St. Louis, Missouri

g Department of Urologic Oncology, University of Miami, Miami, Florida

h Department of Urologic Oncology, Henry Ford Health System, Detroit, Michigan

i Department of Urologic Oncology, 21st Century Oncology, Naples, Florida

j Department of Urologic Oncology, University of North Carolina, Chapel Hill, North Carolina

k Department of Urologic Oncology, Fundaçio Puigvert, Barcelona, Spain

l Department of Urologic Oncology, Arthur Smith Institute for Urology, Long Island, New York

m Department of Urologic Oncology, Urologic Surgical Associates of Delaware, Wilmington, Delaware

n Department of Urologic Oncology, Karolinska University, Stockholm, Sweden

o Department of Urologic Oncology, Cleveland Clinic Foundation, Cleveland, Ohio

Correspondence and requests for reprints: Department of Urologic Oncology, Roswell Park Cancer Institute, Elm and Carlton Sts., Buffalo, New York 14263 (telephone: 716-845-3389; FAX: 716-845-3300)

Study received institutional review board approval.

PII: S0022-5347(10)03014-4

doi:10.1016/j.juro.2010.03.037

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