Oncologic outcomes of robot-assisted radical cystectomy for bladder carcinoma by urinary diversion type.

PURPOSE: To assess oncological outcomes and prognostic factors for recurrence and survival after robot-assisted radical cystectomy (RARC) according to the type of urinary diversion.

METHODS

We conducted a retrospective single-center study including 109 patients who underwent RARC between 2008 and 2022. Clinical, pathological, and follow-up data were analyzed and compared between patients with ileal conduit (Bricker) and those with orthotopic neobladder. Recurrence-free survival (RFS) and overall survival (OS) were estimated using Kaplan-Meier curves. Prognostic factors were evaluated using logistic regression and Cox proportional hazards models.

RESULTS

Among the 109 patients, 74 (67.9%) underwent ileal conduit diversion and 35 (32.1%) received an orthotopic neobladder. Patients in the neobladder group were younger, in better general health (ASA score), and more frequently treated with neoadjuvant chemotherapy (59.6% vs. 21.4%, p = 0.002). Complete pathological response (pT0) was significantly more common after neobladder reconstruction (42.9% vs. 14.9%, p = 0.006). At 5 years, RFS (83.9% vs. 64.7%, p = 0.03) and OS (64.9% vs. 41.8%, p = 0.02) were higher in the neobladder group. On multivariate analysis, impaired health status (ASA 3-4), ileal conduit diversion, lymph node involvement, muscle-invasive disease at cystectomy, and positive surgical margins were identified as independent predictors of worse RFS and OS at both 2 and 5 years.

CONCLUSION

Patients undergoing orthotopic neobladder reconstruction demonstrated better oncological outcomes, primarily reflecting their more favorable baseline characteristics. Nonetheless, lymph node involvement, pathological tumor stage, and patient general health remain the strongest determinants of recurrence and mortality following RARC.