Radical cystectomy-Pentafecta seems useful to assess the quality of RARC surgery in bladder cancer

A significant improvement in overall survival was observed in patients with high-risk bladder cancer who underwent radical-pentafect cystectomy.

According to a study published in Urological oncology.

RC-Pentafecta consisted of no early major complications, no urinary diversion at 12 months or less, no soft tissue in the margins, 16 or more lymph nodes at final pathology, and no clinical recurrence at 12 months. The 5-year OS rate was 71.8% in the RC-Pentafecta group and 59.6% for those who did not experience it (P <.001 the cancer-specific mortality-free survival rate was rc-pentafecta group and in non-rc-pentafecta>P <.001>

A total of 366 patients were enrolled in the study, of whom 191 achieved CR-Pentafecta and 175 did not. who achieved RC-Pentafecta had a 7% lower rate of prostate surgery compared to 26% of those who did not (P = .03). At the time of surgery, there were no statistical differences between age, body mass index, American Society of Anesthesiologist score, Charlson’s comborbidity index, neoadjuvant chemotherapy, and diabetic sugar (P ≥.05).

Those who achieved RC-Pentafecta had less blood loss at 300 ml compared to 350 ml in those who did not achieve RC-Pentafecta (P = 0.007), as well as shorter hospital stays (11 vs. 13 days; P P P <.001>

Additionally, 131 patients achieved pathological T3 and 50 patients had pN-positive disease in the overall population. Those who achieved RC-Pentafecta had lower rates of pT3 disease at 33% compared to 40% for those who did not achieve RC-Pentafecta (P = 0.04), as well as lower surgical margin rates (1.5% versus 14.1%; P <.001 twelve months after cr patients had disease recurrence including with local upper urinary tract and distant recurrence.>

The median follow-up was 29 months, during which those in the RC-Pentafecta group had an overall mortality rate of 26% versus 48% for those who did not achieve RC-Pentafecta, and the CSS was 13% versus 30 %, respectively. Adjuvant chemotherapy (7.8% vs 8%; P = 0.08) and salvage chemotherapy (12% versus 17%; P = 0.03) administration was similar between those who achieved RC-Pentafecta and those who did not.

Significant predictors of overall mortality were found in the Cox proportional hazard regression model, including achieving CR-Pentafecta (HR, 0.53; P = 0.03), pN-positive (HR, 2.19; P = 0.003), pT of 3 or more (HR, 1.74; P = 0.04), orthotopic neo-bladder (HR, 0.48; P = 0.001) and current smoking status (HR, 2.23; P = 0.007) were all significant predictors.

A sensitivity analysis of the Cox proportional hazards regression model found those who underwent robot-assisted CR with ileal conduit, achieving RC-Pentafecta (HR, 0.42; P = 0.005), positive surgical margins (HR, 2.30; P = 0.005), pN-positive (HR, 2.36; P = 0.003), pT of 3 or more (HR, 1.32; P = 0.02) and current smoking status (HR, 2.23; P = 0.007) were predictors of overall mortality.

Reference

Piazza P, Bravi CA, Puliatti S, et al. Evaluation of pentafecta achievement after robot-assisted radical cystectomy and its association with surgical experience: results from a high-volume institution. Urol Oncol. Published online January 27, 2022. doi:10.1016/j.urolonc.2022.01.001

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