{"id":1512,"date":"2022-01-29T12:57:19","date_gmt":"2022-01-29T11:57:19","guid":{"rendered":"https:\/\/drstefanopuliatti.com\/non-categorizzato\/assessing-pentafecta-achievement-after-robot-assisted-radical-cystectomy-and-its-association-with-surgical-experience-results-from-a-high-volume-institution\/"},"modified":"2022-01-29T12:57:19","modified_gmt":"2022-01-29T11:57:19","slug":"assessing-pentafecta-achievement-after-robot-assisted-radical-cystectomy-and-its-association-with-surgical-experience-results-from-a-high-volume-institution","status":"publish","type":"post","link":"https:\/\/drstefanopuliatti.com\/en\/scientific-articles\/assessing-pentafecta-achievement-after-robot-assisted-radical-cystectomy-and-its-association-with-surgical-experience-results-from-a-high-volume-institution\/","title":{"rendered":"Assessing pentafecta achievement after robot-assisted radical cystectomy and its association with surgical experience: Results from a high-volume institution"},"content":{"rendered":"[vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; scene_position=&#8221;center&#8221; text_color=&#8221;dark&#8221; text_align=&#8221;left&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; shape_divider_position=&#8221;bottom&#8221; bg_image_animation=&#8221;none&#8221;][vc_column column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; column_element_spacing=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/1&#8243; tablet_width_inherit=&#8221;default&#8221; tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; bg_image_animation=&#8221;none&#8221; border_type=&#8221;simple&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221;][vc_column_text]Piazza P, Bravi CA,\u00a0Puliatti S, Cacciamani GE, Knipper S, Amato M, Dell&#8217;Oglio P, Mazzone E, Rosiello G, Farinha R, Sarchi L, Scarcella S, Wisz P, Schiavina R, Develtere D, De Backer P, De Groote R, D&#8217;Hondt F, Mottrie A[\/vc_column_text][\/vc_column][\/vc_row][vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; scene_position=&#8221;center&#8221; text_color=&#8221;dark&#8221; text_align=&#8221;left&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; shape_divider_position=&#8221;bottom&#8221; bg_image_animation=&#8221;none&#8221;][vc_column column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; column_element_spacing=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/1&#8243; tablet_width_inherit=&#8221;default&#8221; tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; bg_image_animation=&#8221;none&#8221; border_type=&#8221;simple&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221;][vc_column_text]\n<ul>\n<li>PMID: 35094932<\/li>\n<li><span class=\"identifier doi\"><span class=\"id-label\">DOI:\u00a0<\/span><a class=\"id-link\" href=\"https:\/\/doi.org\/10.1016\/j.urolonc.2022.01.001\" target=\"_blank\" rel=\"noopener\" data-ga-category=\"full_text\" data-ga-action=\"DOI\">10.1016\/j.urolonc.2022.01.001<\/a><\/span><\/li>\n<\/ul>\n[\/vc_column_text][nectar_btn size=&#8221;jumbo&#8221; open_new_tab=&#8221;true&#8221; button_style=&#8221;regular&#8221; button_color_2=&#8221;Accent-Color&#8221; icon_family=&#8221;none&#8221; text=&#8221;full article at pubmed.gov&#8221; url=&#8221;https:\/\/pubmed.ncbi.nlm.nih.gov\/35094932\/&#8221;][\/vc_column][\/vc_row][vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; scene_position=&#8221;center&#8221; text_color=&#8221;dark&#8221; text_align=&#8221;left&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; shape_divider_position=&#8221;bottom&#8221; bg_image_animation=&#8221;none&#8221;][vc_column column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; column_element_spacing=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/1&#8243; tablet_width_inherit=&#8221;default&#8221; tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; bg_image_animation=&#8221;none&#8221; border_type=&#8221;simple&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221;][vc_column_text]\n<h4>Abstract<\/h4>\n[\/vc_column_text][vc_column_text]<strong>Objectives<\/strong>: Radical cystectomy (RC) represents the gold standard treatment for high-risk bladder cancer. Despite evidence suggesting that surgical experience correlates with perioperative and oncologic outcomes of robot-assisted RC (RARC), validated tools to assess its quality objectively are lacking. We aimed to evaluate the impact of RC-Pentafecta (absence of early major complications, absence of urinary diversion related sequelae at \u226412 months, absence of soft tissue surgical margins, \u226516 lymph nodes at final pathology and absence of clinical recurrence at \u226412 months) on oncological outcomes and the role of surgical experience on its achievement.<\/p>\n<p><strong>Materials and methods<\/strong>: We retrospectively evaluated 366 patients undergoing RARC with intracorporeal urinary diversion in a single tertiary centre with a minimum of 1 year follow-up. Surgeries were performed using the DaVinci Xi system according to a previously described technique. Kaplan-Meier curves were used to investigate 5-years overall survival and cancer specific mortality-free survival (CSS) according to RC-Pentafecta achievement. Multivariable Cox&#8217;s regressions were performed to evaluate the impact of RC-Pentafecta on overall mortality. Multivariable logistic regressions were performed to explore the effect of surgical experience on RC-pentafecta achievement. Locally weighted scatterplot smoother function was used to graphically explore this relationship.<\/p>\n<p>Results: Patients achieving RC-Pentafecta showed higher 5-year overall survival (71.8% vs. 59.6%, P &lt; 0.001) and CSS (84% vs. 71%, P &lt; 0.001) when compared with patients not achieving it. At multivariable Cox&#8217;s regression, RC-Pentafecta achievement (HR 0.57, P = 0.03), positive surgical margins (HR 2.48, P = 0.002), pN+ (HR 2.23, P = 0.002), pT\u22653 (HR 1.71, P = 0.04) and current smoking status (HR 2.4, P = 0.006) were significant predictors of overall mortality. At multivariable logistic regression surgical experience (OR 1.2, P &lt; 0.001), age (OR 0.93, P = 0.04), previous prostate surgery (OR 0.7, P = 0.02) and pT\u22653 (OR 0.8, P = 0.03) were independent predictors of RC-Pentafecta achievement. A linear relationship between surgical experience and RC-Pentafecta achievement, without reaching a plateau, was observed.<\/p>\n<p><strong>Conclusions<\/strong>: RC-Pentafecta is a valuable tool to assess surgical quality of RARC and the experience of the center where the surgery is performed and may be used to identify &#8220;referral&#8221; centers for treatment of high-risk bladder cancer.<\/p>\n<p>Keywords: Complications; Cystectomy; Intracorporeal urinary diversion; Minimally invasive surgery; Oncologic outcomes; Pentafecta; Robot assisted cystectomy; Surgical experience.<\/p>\n<p>Copyright \u00a9 2022 Elsevier Inc. All rights reserved.[\/vc_column_text][\/vc_column][\/vc_row][vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; column_direction_phone=&#8221;default&#8221; scene_position=&#8221;center&#8221; text_color=&#8221;dark&#8221; text_align=&#8221;left&#8221; row_border_radius=&#8221;none&#8221; row_border_radius_applies=&#8221;bg&#8221; overlay_strength=&#8221;0.3&#8243; gradient_direction=&#8221;left_to_right&#8221; shape_divider_position=&#8221;bottom&#8221; bg_image_animation=&#8221;none&#8221;][vc_column column_padding=&#8221;no-extra-padding&#8221; column_padding_tablet=&#8221;inherit&#8221; column_padding_phone=&#8221;inherit&#8221; column_padding_position=&#8221;all&#8221; column_element_spacing=&#8221;default&#8221; background_color_opacity=&#8221;1&#8243; background_hover_color_opacity=&#8221;1&#8243; column_shadow=&#8221;none&#8221; column_border_radius=&#8221;none&#8221; column_link_target=&#8221;_self&#8221; gradient_direction=&#8221;left_to_right&#8221; overlay_strength=&#8221;0.3&#8243; width=&#8221;1\/1&#8243; tablet_width_inherit=&#8221;default&#8221; tablet_text_alignment=&#8221;default&#8221; phone_text_alignment=&#8221;default&#8221; bg_image_animation=&#8221;none&#8221; border_type=&#8221;simple&#8221; column_border_width=&#8221;none&#8221; column_border_style=&#8221;solid&#8221;][vc_column_text]\n<h4>Conflict of interest statement<\/h4>\n[\/vc_column_text][vc_column_text]Declaration of interest The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.[\/vc_column_text][\/vc_column][\/vc_row]\n","protected":false},"excerpt":{"rendered":"<p>[vc_row type=&#8221;in_container&#8221; full_screen_row_position=&#8221;middle&#8221; column_margin=&#8221;default&#8221; column_direction=&#8221;default&#8221; column_direction_tablet=&#8221;default&#8221; 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Da Luglio 2019 ricopre il ruolo di Assistant Professor in Urologia presso l'Universit\u00e0 di Modena e Reggio Emilia. Da Luglio 2019 ricopre anche il ruolo di Deputy Medical Director of ORSI Academy, Melle, Belgio e svolge attivit\u00e0 clinica e chirurgica presso OLV (Onze Lieve Vrouwziekenhuis) Hospital in Aalst, Belgio (direttore: Prof. Alex Mottrie). La sua formazione si \u00e8 incentrata in particolare sulla Chirurgia robotica e oncologica delle vie urinarie, avendo come principali campi di applicazione anche tumori e malattie della prostata, tumori del rene e delle alte vie urinarie, disturbi minzionali, calcolosi delle vie urinarie. \u00c8 inoltre autore e coautore di articoli scientifici e capitoli di libro in ambito urologico. 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Da Luglio 2019 ricopre il ruolo di Assistant Professor in Urologia presso l'Universit\u00e0 di Modena e Reggio Emilia. Da Luglio 2019 ricopre anche il ruolo di Deputy Medical Director of ORSI Academy, Melle, Belgio e svolge attivit\u00e0 clinica e chirurgica presso OLV (Onze Lieve Vrouwziekenhuis) Hospital in Aalst, Belgio (direttore: Prof. Alex Mottrie). La sua formazione si \u00e8 incentrata in particolare sulla Chirurgia robotica e oncologica delle vie urinarie, avendo come principali campi di applicazione anche tumori e malattie della prostata, tumori del rene e delle alte vie urinarie, disturbi minzionali, calcolosi delle vie urinarie. \u00c8 inoltre autore e coautore di articoli scientifici e capitoli di libro in ambito urologico. 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