Robot-assisted Laparoscopic Implantation of Brachytherapy Catheters in Bladder Cancer.

ABSTRACT

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 ≤5cm or cN0M0 UraC were scheduled for external beam radiotherapy (20×2Gy), RAL BTC implantation, and pulsed-dose (29×1.04Gy) or high-dose rate brachytherapy (10×2.50Gy). 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 <50ml 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.