TY - JOUR
T1 - Robot-assisted Laparoscopic Implantation of Brachytherapy Catheters in Bladder Cancer
AU - Bosschieter, Judith
AU - Vis, André N.
AU - van der Poel, Henk G.
AU - Moonen, Luc M.
AU - Horenblas, Simon
AU - van Rhijn, Bas W.G.
AU - Pieters, Bradley R.
AU - Nieuwenhuijzen, Jakko A.
AU - Hendricksen, Kees
PY - 2018/9/1
Y1 - 2018/9/1
N2 - Background: Robot-assisted laparoscopic (RAL) implantation of brachytherapy catheters (BTCs) can be a minimally invasive alternative to open retropubic implantation. Descriptions of the surgical technique and outcomes are sparse. Objective: To describe our technique and perioperative outcomes for RAL BTC implantation in urothelial carcinoma (UC) and urachal carcinoma (UraC). Design, setting and participants: Between June 2011 and May 2016, 26 patients with cN0M0 solitary T1G3 or T2G1-3 UC of ≤5. cm or cN0M0 UraC were scheduled for external beam radiotherapy (20. ×. 2. Gy), RAL BTC implantation, and pulsed-dose (29. ×. 1.04. Gy) or high-dose rate brachytherapy (10. ×. 2.50. Gy). Median follow-up was 12 mo (interquartile range 4-20). Surgical procedure: RAL BTC implantation with or without pelvic lymph node dissection and/or partial cystectomy. Measurements and statistical analysis: Perioperative data, complications, disease-free-survival (DFS), local recurrence-free survival (LRFS), and cystectomy-free survival (CFS) were evaluated as well as the feasibility of the technique. Results and limitations: BTC implantation was successful in 92% of the patients. Median hospitalisation was 5 d (interquartile range 4-7) and blood loss <50. ml in all cases. DFS was 74% at 1 yr and 63% at 2 yr. LRFS was 80% at 1 and 2 yr, and CFS was 87% at 1 and 2 yr. Early (≤30 d) high-grade complications (Clavien-Dindo ≥3) occurred in 8% of the patients. The study is limited by the small sample size and short follow-up time. Conclusions: RAL BTC implantation is technically feasible and could serve as safe, minimally invasive alternative to open surgery in selected patients. The results of this study should be confirmed in larger studies. Patient summary: Brachytherapy catheter (BTC) implantation is traditionally carried out via open retropubic surgery. We describe robot-assisted laparoscopic BTC implantation as a minimally invasive alternative. Perioperative outcomes are described and confirm the safety and feasibility of this procedure. Robot-assisted laparoscopic implantation of brachytherapy catheters is technically feasible with good perioperative outcomes. Short-term oncological results are promising, and should be confirmed in a larger cohort with longer follow-up.
AB - Background: Robot-assisted laparoscopic (RAL) implantation of brachytherapy catheters (BTCs) can be a minimally invasive alternative to open retropubic implantation. Descriptions of the surgical technique and outcomes are sparse. Objective: To describe our technique and perioperative outcomes for RAL BTC implantation in urothelial carcinoma (UC) and urachal carcinoma (UraC). Design, setting and participants: Between June 2011 and May 2016, 26 patients with cN0M0 solitary T1G3 or T2G1-3 UC of ≤5. cm or cN0M0 UraC were scheduled for external beam radiotherapy (20. ×. 2. Gy), RAL BTC implantation, and pulsed-dose (29. ×. 1.04. Gy) or high-dose rate brachytherapy (10. ×. 2.50. Gy). Median follow-up was 12 mo (interquartile range 4-20). Surgical procedure: RAL BTC implantation with or without pelvic lymph node dissection and/or partial cystectomy. Measurements and statistical analysis: Perioperative data, complications, disease-free-survival (DFS), local recurrence-free survival (LRFS), and cystectomy-free survival (CFS) were evaluated as well as the feasibility of the technique. Results and limitations: BTC implantation was successful in 92% of the patients. Median hospitalisation was 5 d (interquartile range 4-7) and blood loss <50. ml in all cases. DFS was 74% at 1 yr and 63% at 2 yr. LRFS was 80% at 1 and 2 yr, and CFS was 87% at 1 and 2 yr. Early (≤30 d) high-grade complications (Clavien-Dindo ≥3) occurred in 8% of the patients. The study is limited by the small sample size and short follow-up time. Conclusions: RAL BTC implantation is technically feasible and could serve as safe, minimally invasive alternative to open surgery in selected patients. The results of this study should be confirmed in larger studies. Patient summary: Brachytherapy catheter (BTC) implantation is traditionally carried out via open retropubic surgery. We describe robot-assisted laparoscopic BTC implantation as a minimally invasive alternative. Perioperative outcomes are described and confirm the safety and feasibility of this procedure. Robot-assisted laparoscopic implantation of brachytherapy catheters is technically feasible with good perioperative outcomes. Short-term oncological results are promising, and should be confirmed in a larger cohort with longer follow-up.
KW - Bladder-preserving therapy
KW - Brachytherapy
KW - Robotic surgical procedures
KW - Urinary bladder neoplasm
UR - http://www.scopus.com/inward/record.url?scp=85020461753&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.eururo.2017.05.054
DO - https://doi.org/10.1016/j.eururo.2017.05.054
M3 - Article
C2 - 28619396
SN - 0302-2838
VL - 74
SP - 369
EP - 375
JO - European Urology
JF - European Urology
IS - 3
ER -