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Platinum Priority – Brief Correspondence

Editorial by Nieroshan Rajarubendra and Monish Aron on pp. 727–728 of this issue

Early Recurrence Patterns Following Totally Intracorporeal

Robot-assisted Radical Cystectomy: Results from the

EAU Robotic Urology Section (ERUS) Scientific Working Group

Justin W. Collins

a ,

Abolfazl Hosseini

a ,

Christofer Adding

a ,

Tommy Nyberg

b ,

Anthony Koupparis

c ,

Edward Rowe

c ,

Matthew Perry

d ,

Rami Issa

d ,

Martin C. Schumacher

e ,

Carl Wijburg

f ,

Abdullah E. Canda

g ,

Melvin D. Balbay

h ,

Karel Decaestecker

i ,

Christian Schwentner

j ,

Arnulf Stenzl

j ,

Sebastian Edeling

k ,

Sasˇa Pokupic´

k ,

Fredrik D’Hondt

l ,

Alexander Mottrie

l ,

Peter N. Wiklund

a , *


Karolinska University Hospital, Stockholm, Sweden;


Karolinska Institute, Stockholm, Sweden;


Bristol Urological Institution, Bristol, UK;


St. Georges

Hospital London, London, UK;


Hirslanden Klinik, Aarau, Switzerland;


Carl Wijburg, Rijnstate, Arnhem, The Netherlands;


Ankara Ataturk Hospital, Ankara,



Memorial Sisli Hospital, Istanbul, Turkey;


Ghent University Hospital, Ghent, Belgium;


University of Tu¨bingen, Tu¨bingen, Germany;


Da Vinci

Zentrum, Hanover, Germany;


O.L.V, Clinic, Aalst, Belgium

E U R O P E A N U R O L O G Y 7 1 ( 2 0 1 7 ) 7 2 3 – 7 2 6

ava ilable at

journal homepage:

Article info

Article history:

Accepted October 17, 2016

Associate Editor:

James Catto


Robot-assisted radical


Early recurrence patterns

Oncologic outcomes

Totally intracorporeal robot-

assisted radical cystectomy

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Recurrence following radical cystectomy often occurs early, with


80% of recurrences

occurring within the first 2 yr. Debate remains as to whether robot-assisted radical

cystectomy (RARC) negatively impacts early recurrence patterns because of inadequate

resection or pneumoperitoneum. We report early recurrence patterns among

717 patients who underwent RARC with intracorporeal urinary diversion at nine

different institutions with a minimum follow-up of 12 mo. Clinical, pathologic, radio-

logic, and survival data at the latest follow-up were collected. Recurrence-free survival

(RFS) estimates were generated using the Kaplan-Meier method, and Cox regression

models were built to assess variables associated with recurrence. RFS at 3, 12, and 24 mo

was 95.9%, 80.2%, and 74.6% respectively. Distant recurrences most frequently occurred

in the bones, lungs, and liver, and pelvic lymph nodes were the commonest site of local

recurrence. We identified five patients (0.7%) with peritoneal carcinomatosis and two

patients (0.3%) with metastasis at the port site (wound site). We conclude that unusual

recurrence patterns were not identified in this multi-institutional series and that

recurrence patterns appear similar to those in open radical cystectomy series.

Patient summary:

In this multi-institutional study, bladder cancer recurrences follow-

ing robotic surgery are described. Early recurrence rates and locations appear to be

similar to those for open radical cystectomy series.


2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.

* Corresponding author. Department of Urology, Karolinska University Hospital, 171 76 Stockholm,

Sweden. Tel. +46 8 51772854; Fax: +46 8 51773599.

E-mail address:

(P.N. Wiklund).



2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.