MP56-13: Perioperative And Survival Outcomes of Patients with A History Of Pelvic Radiation Undergoing Salvage Robot-Assisted Radical Cystectomy. An RRC-ICUD Collaborative Study
Introduction: There are lack of data on salvage robot-assisted radical cystectomy (sRRC) after pelvic radiation therapy (RT) in patients with bladder cancer. We present perioperative, oncological, and long terms survival outcomes for patients with a history of pelvic radiation who had undergone sRRC from 3 high-volume centers. Methods: Data from prospectively maintained databases from 3 centers (USC, Karolinska Institute, Mount Sinai) from 2009-2019 were retrospectively reviewed. Patients with a history of pelvic radiation who underwent sRRC with Intracorporeal (ICUD) or extracorporeal (ECUD) for intent to cure bladder cancer were identified. Using a propensity score estimation (based on age, BMI, gender, ASA score, neoadjuvant chemotherapy, and clinical tumor stage (Caliper size 0.2), patients were matched 1:1 to a cohort undergoing RRC without prior history of pelvic radiation. Both groups were compared for perioperative, oncologic, and survival outcomes with up to 3 years of follow-up. Results: A total of 92 sRRC were PS matched to 92 patients undergoing RRC. While both groups were similar in the proportion of ICUD (70.3 vs 78.3%, p=0.29),the sRRC had a lower proportion of continent diversion(6.7 vs 22.8%, p=0.004)). There were no significant differences between the 2 groups in operative time (333.8 vs 348.2 minutes, p=0.246), postoperative complications, at 30 days (p=0.36), and 31-90 days (p=0.64), and readmission rates at 30 days (16.3 vs 19.6%, p=0.70) and 31-90 days (16.5 vs 21.8%, p=0.48). The sRRC group had a lower number of lymph nodes (LNDs) retrieved (20.1 vs 29, p= <0.001), positive LNDs (0.3 vs 1.7, p=0.007), and positive LNDs rate (0.03 vs 0.07%, p=0.035). However no significant differences observed in tumor stage (p=0.41) and LNDs stage (p= 0.065) and rate (23.9 vs 29.3;p=0.5). At 3 years, OSS (59.1 vs 67.8% p=0.27), CSS (74.9 vs 74.4% p=0.59), and RFS ( 70.7 vs 76.1 p=0.67) were similar between sRRC and RRC. Conclusions: This largest multi-institutional contemporary study provides the best evidence to date supporting the feasibility of sRRC. Perioperative and survival outcomes were comparable between the two groups indicating that sRRC is feasible for selected patients who have underwent pelvic RT. SOURCE OF Funding: none
