RADICAL CYSTECTOMY PENTAFECTA: A PROPOSAL FOR STANDARDIZATION OF OUTCOMES REPORTING FOLLOWING ROBOT ASSISTED RADICAL CYSTECTOMY

You have accessJournal of UrologyBladder Cancer: Invasive II (MP32)1 Apr 2019MP32-12 RADICAL CYSTECTOMY PENTAFECTA: A PROPOSAL FOR STANDARDIZATION OF OUTCOMES REPORTING FOLLOWING ROBOT ASSISTED RADICAL CYSTECTOMY Giovanni Cacciamani*, Matthew Winter, Luis Medina, Akbar Ashrafi, Gus Miranda, Hannah Landberger, Michael Lin-Brande, Alessandro Tafuri, Nieroshan Rajarubendra, Andre De Castro Abreu, Andre Berger, Monish Aron, Inderbir Gill, and Mihir Desai Giovanni Cacciamani*Giovanni Cacciamani* More articles by this author , Matthew WinterMatthew Winter More articles by this author , Luis MedinaLuis Medina More articles by this author , Akbar AshrafiAkbar Ashrafi More articles by this author , Gus MirandaGus Miranda More articles by this author , Hannah LandbergerHannah Landberger More articles by this author , Michael Lin-BrandeMichael Lin-Brande More articles by this author , Alessandro TafuriAlessandro Tafuri More articles by this author , Nieroshan RajarubendraNieroshan Rajarubendra More articles by this author , Andre De Castro AbreuAndre De Castro Abreu More articles by this author , Andre BergerAndre Berger More articles by this author , Monish AronMonish Aron More articles by this author , Inderbir GillInderbir Gill More articles by this author , and Mihir DesaiMihir Desai More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000555881.83901.8eAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: To propose a standardisable composite method for reporting outcomes of radical cystectomy (RC) that incorporates both peri-operative morbidity and oncologic adequacy. METHODS: From July 2010 through December 2017, 277 consecutive patients who underwent robotic radical cystectomy (RRC) for bladder cancer at our institution were prospectively analysed. IRB approval was obtained (HS-01B014). Patients who simultaneously demonstrated negative soft tissue surgical margins, =/> 16 lymph node yield, absence of major (Clavien-Dindo grade III-IV) complications at 90 days, absence of urinary diversion (UD) related long-term sequelae and absence of clinical recurrence at =/< 12 mo. were considered as having achieved the RC-pentafecta. We created a multivariable logistic regression model using age, ASA score, type of UD, NACH, pT and pN stage as covariates to measure independent factors for achieving RC-pentafecta. The internal validity of the prediction model was assessed by 1,000 bootstrap samples with a two-tailed p-value less than 0.05 being statistically significant. (SPSS 24 Inc., Chicago, IL, USA). RESULTS: Since 2010, 270 out of 277 patients that had completed at least 12mo. follow-up were included in this analysis. Over a median follow up of 39.5 months, =/> 16 lymph node yield, negative soft surgical margins, absence of major complications at 90 days and absence of UD-related surgical sequelae and clinical recurrence at =/< 12 months were observed in 93.0%, 98.9%, 76.7%, 81.5% and 92.2%, patients, respectively resulting in a RC-pentafecta of 53.3% (Fig. a). When comparing UD, IC was showed higher RC-pentafecta rate (Fig. B). Multivariable logistic regression analysis revealed age (OR:0.95; p=0.002), type of UD (OR: 2.19; p= 0.01) and pN stage (OR: 0.48; p= 0.03) to be independent predictors for achieving RC-pentafecta. RC-Pentafecta increased from 44.4% to 64.4% in I and III tirtile respectively (Fig. C). CONCLUSIONS: We present RC-pentafecta as a standardisable composite endpoint that incorporates peri-operative morbidity and oncologic adequacy as a potential tool to assess quality of radical cystectomy. This tool may be useful for assessing learning curve and calculating cost effectiveness amongst others but needs to be externally validated in future studies. Source of Funding: none Los Angeles, CA© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e447-e448 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Giovanni Cacciamani* More articles by this author Matthew Winter More articles by this author Luis Medina More articles by this author Akbar Ashrafi More articles by this author Gus Miranda More articles by this author Hannah Landberger More articles by this author Michael Lin-Brande More articles by this author Alessandro Tafuri More articles by this author Nieroshan Rajarubendra More articles by this author Andre De Castro Abreu More articles by this author Andre Berger More articles by this author Monish Aron More articles by this author Inderbir Gill More articles by this author Mihir Desai More articles by this author Expand All Advertisement PDF downloadLoading ...