Effects of Robot-Assisted Radical Cystectomy on Peritoneal Carcinomatosis and Prognosis in Patients With Muscle-Invasive Bladder Cancer: A Multicenter Retrospective Study.

OBJECTIVES

We compared the effects of robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC) on the incidence of peritoneal carcinomatosis and prognosis in patients with muscle-invasive bladder cancer (MIBC) in real-world practice.

METHODS

This retrospective study included 429 patients who underwent radical cystectomy, including RARC (n = 151) and ORC (n = 278), at Hirosaki University Hospital and Ageo Central General Hospital from 2011 to 2024. The incidence of peritoneal carcinomatosis was compared between the RARC and ORC groups. Potential risk factors for peritoneal carcinomatosis were identified using multivariable logistic regression analysis. The impact of peritoneal carcinomatosis on overall survival was evaluated using the Kaplan-Meier method and multivariable Cox regression analysis.

RESULTS

The incidence of peritoneal carcinomatosis was low and not significantly different between the ORC (n = 13, 4.7%) and RARC (n = 6, 4.0%) groups. Multivariate logistic regression analysis revealed that clinical high-risk (cT3-4 or cN+) was significantly associated with an increased risk of peritoneal carcinomatosis (odds ratio: 5.03, 95% confidence interval 1.34-18.8, p = 0.016) after ORC but not RARC. Neoadjuvant chemotherapy significantly reduced the risk of peritoneal carcinomatosis. Recurrence-free and overall survival were similar between RARC and ORC in patients with peritoneal carcinomatosis. Multivariate Cox regression analyses showed that pathological high-risk and peritoneal carcinomatosis but not RARC were significantly associated with poor overall survival.

CONCLUSIONS

No significant differences in the atypical recurrence pattern of peritoneal carcinomatosis were detected between RARC and ORC. Neoadjuvant chemotherapy may reduce the risk of peritoneal carcinomatosis.