Critical Analysis of Early Recurrence after Laparoscopic Radical Cystectomy in a Large Cohort by the ESUT

Purpose: We analyze patients with early progression after laparoscopic radicalcystectomy in a large cohort by the ESUT (European Association of UrologySection of Uro-Technology). More specifically we focus on patients with favorablepathology (pT2 N0 R0 or less) who experienced an unexpected recurrence andanalyze possible causes for such early recurrence, discussing the surgical tech-nique including pneumoperitoneum.Materials and Methods: Since 2000 the ESUT has been constructing a large,multicenter, prospective database of patients undergoing laparoscopic radicalcystectomy. All procedures were performed via a standard laparoscopic approachwithout robotic assistance. We specifically analyzed patients with favorablepathological characteristics, in particular pT2 N0 R0 or less, and evaluated thosewith progression despite these favorable characteristics. Univariate and multi-variate logistic regression was performed to evaluate risk factors for earlyrecurrence.Results: A total of 627 patients were available for final analysis with a medianfollowup of 46 months (mean 57). Of these patients 311 had favorable patho-logical characteristics of pT2 N0 R0 or less. During followup 27 (8.7%) patientsexperienced disease progression during the first 24 months. Surgical negligencewas found in only 1 case. Most of these patients with early recurrence hadprogression to high tumor volume disseminated metastatic disease. On multi-variate logistic regression tumor stage was the only factor significantly associ-ated with early recurrence (p¼0.027