Long-term multicentre analysis of robot-assisted radical cystectomy for non-muscle-invasive bladder cancer.

Objective: To evaluate the 12-year survival outcomes of patients with non-muscle-invasive bladder cancer (NMIBC) who underwent robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD), focusing on those upstaged to ≥pT2 or with node-positive disease.

Methods: A multicentre, prospectively maintained database (2004-2022) was reviewed to identify patients who had undergone RARC. Univariable and multivariable models were used to assess upstaging (≥pT2, ≥pN1), and Kaplan-Meier curves were used to predict cancer-specific survival (CSS) and overall survival (OS).

Results: Among 355 patients with NMIBC (295 men, 60 women), 12.68% had pT2, 8.2% had pT3, 4.2% had pT4, 5.4% had pN1, and 2.8% had pN2 disease. Age ≥ 83 years (odds ratio [OR] 19.7), presence of carcinoma in situ (CIS), in combination with Ta/ T1 bladder cancer (OR 2.7), squamous cell carcinoma (OR 6.6), and variant histology (OR 6.2), predicted upstaging. A body mass index ≥28 kg/m2 (OR 0.4) and Tis alone (OR 0.1) reduced upstaging. The OS rate for the entire cohort was 93% at 1 year, 87% at 5 years and 49% at 12 years. The CSS rate was 97% at 1 year, 83% at 5 years and 76% at 12 years. At 12 years, OS was better in the non-upstaged cohort (52%, 95% confidence interval [CI] 37%-74%) vs the upstaged cohort (39%, 95% CI 26%-57%). CSS was higher in the non-upstaged cohort (79%, 95% CI 71%-88%; P < 0.001) vs the upstaged cohort (68%, 95% CI 56%-82%; P < 0.001).

Conclusions: This study provides the longest follow-up data on RARC in NMIBC. The presence of CIS, variant histology, and pT1 on transurethral resection of the bladder tumour were predictors of upstaging, which correlated with higher recurrence and worse survival. RARC with ICUD is a minimally invasive option for NMIBC patients who need to undergo early cystectomy, offering comparable long-term outcomes.