Oncologic outcomes after robot assisted radical cystectomy in patients with clinically positive lymph nodes (cN1): a tertiary referral center experience

BACKGROUND: The aim of the article is to assess perioperative and oncological features of patients with clinically positive lymph nodes treated with RARC wit intracorporeal urinary diversion in a large contemporary cohort. METHODS: Consecutive patients treated from January 2016 to January 2025 with RARC, lymph node dissection (LND) and intracorporeal reconfiguration for cT1-3 N0-N1 M0 BCa were included. Follow-up schedule included blood analysis and CT scan performed three months after surgery, then every 6 months from the first to the third postoperative year, followed by annual imaging. RESULTS: Overall, 324 patients treated with RARC + LND were included. Of these, the 19% was female. The median age was 69 (61-75) years while the median CCI was 3 (2-4). In terms of intraoperative features, no significant differences were recorded with a median operative time was 366 (317-396) vs. 377 (312-442) minutes while an extended LND template was performed in the 39 vs. 49% of cases in the cN0 and cN1 groups, respectively (P=0.015). Overall postoperative complications occurred in the 28% of patients and the rate of major complications was not different between the two groups (9.1 vs. 13%, P=0.9). After a median follow-up of 38 (24-45) months, disease free survival was 69 vs. 34% with a median time to recurrence of 12 vs. 9 months in the cN0 and cN1 groups (P=0.05 and P=0.04, respectively). In terms of survival analyses, the cN1 groups was associated with significantly lower rates of CSS (79 vs. 40.2%, P=0.001), and OS (65 vs. 33%, P=0.001, respectively). CONCLUSIONS: In a cohort of cN1 patients, RARC shows worthy oncological outcomes with disease recurrence and cancer-specific mortality rates consistent to open surgical series and no evidence of atypical recurrences.