Partial cystectomy for bladder cancer using a laparoscopic or robotic-assisted approach is not associated with an increased risk of positive surgical margins (PSMs) compared with an open procedure, investigators concluded.
In a study that included 1118 patients undergoing partial cystectomy identified using the National Cancer Data Base, a team at the University of Miami Miller School of Medicine led by Mark L. Gonzalgo, MD, PhD, found that the rate of PSMs was 19.6%, 18.2%, and 21.6% among patients treated with an open, laparoscopic, and robotic-assisted procedure, respectively, with no significant differences in the rate of PSMs among the groups, according to a report in the Urologic Oncology. The investigators found no significant differences in adjusted odds ratios among the surgical approaches.
“Our results suggest that partial cystectomy using the laparoscopic or robotic-assisted approach does not carry a higher risk of PSMs and that tumor location and biology, rather than surgical approach, may be the important determinants of PSMs,” the authors concluded.
The study also identified risk factors for PSMs. In adjusted analyses, muscle-invasive bladder cancer was significantly associated with nearly 3.3-fold increased odds of PSMs compared with nonmuscle-invasive disease. Compared with tumors smaller than 3 cm, larger tumors were significantly associated with 67% increased odds of PSM. Non-Hispanic blacks had significant 1.9-fold increased odds of PSMs compared with non-Hispanic whites.
Dr Gonzalgo and his collaborators explained that robotic-assisted techniques, including partial cystectomy, will continue to be used with increasing frequency for the management of bladder cancer. They pointed out that the lack of haptic feedback is a major difference between robotic-assisted surgical techniques and open and laparoscopic procedures. Therefore, they wrote, it is essential to evaluate whether PSM rates for robotic-assisted partial cystectomy are comparable to those of open and laparoscopic techniques. As far as they are aware, their study is the first to assess surgical margin status by different surgical approaches for partial cystectomy, Dr Gonzalgo’s team noted.
Of the 1118 patients, 715 (64%), 209 (18.7%), and 194 (17.4%) underwent open, laparoscopic, and robotic-assisted partial cystectomy, respectively. The study population had a mean age at diagnosis of 71 years, with no significant differences in age among the surgical groups.
Owyong M, Koru-Sengul T, Miao F, et al. Impact of surgical technique on surgical margin status following partial cystectomy [published online August 21, 2019]. Urol Oncol. doi:10.1016/j.urolonc.2019.07.018