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Long-Term Outcomes of Robot-Assisted Radical Cystectomy in Patients with Non-Muscle-Invasive Bladder Cancer - Expert Commentary

Radical cystectomy is an effective treatment option for high-risk, non-muscle-invasive bladder cancer (NMIBC) to prevent progression. A recent 12-year multicenter study evaluated survival outcomes of patients with NMIBC who underwent robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD).

The researchers reviewed a multicenter database (2004-2022) of 355 NMIBC patients (295 men, 60 women) who underwent RARC. Notably, 34.4% had upstaging to muscle-invasive or node-positive disease. Age ≥83 years (odds ratio 19.7), presence of carcinoma in situ combined with Ta/T1 bladder cancer (OR 2.7), squamous cell carcinoma (OR 6.6), and variant histology (OR 6.2) were significant predictors of upstaging. Overall survival rates were 93% at 1 year, 87% at 5 years, and 49% at 12 years, with cancer-specific survival rates of 97%, 83%, and 76% at the same intervals. The non-upstaged cohort demonstrated significantly better 12-year overall survival (52% vs 39%) and cancer-specific survival (79% vs 68%) compared to the group that had upstaging.

This study provides long-term follow-up on RARC for NMIBC patients. The investigators conclude that RARC with ICUD is a minimally invasive option offering comparable long-term outcomes for NMIBC patients requiring early cystectomy, especially in cases with high-risk features like CIS, variant histology, and T1 disease on initial biopsy.

Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine

References:

  1. Tillu N, Ben-David R, Skokic V, Rich JM, Kolanukuduru KP, Dey L, Rautiola J, Björklund J, Almoflihi M, Eraky A, Miranda G, Cacciamani G, Desai M, Mehrazin R, Sfakianos JP, Wiklund P. Long-term multicentre analysis of robot-assisted radical cystectomy for non-muscle-invasive bladder cancer. BJU Int. 2025 Feb 20. doi: 10.1111/bju.16686. Online ahead of print. PMID: 39980082.
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