Prognostic Significance of Achieving the Radical Cystectomy‐Pentafecta After Neoadjuvant Chemotherapy and Robot‐Assisted Radical Cystectomy

Objective This collaborative, multi‐institutional retrospective study aimed to evaluate whether achieving the radical cystectomy‐pentafecta contributes to improved outcomes in patients with muscle‐invasive bladder cancer undergoing neoadjuvant chemotherapy followed by robot‐assisted radical cystectomy. Methods We retrospectively analyzed 195 patients with muscle‐invasive bladder cancer who underwent robot‐assisted radical cystectomy with intracorporeal urinary diversion at four affiliated institutions. All had a minimum follow‐up of 12 months. According to previously established criteria, patients who simultaneously demonstrated (i) negative soft tissue surgical margins, (ii) ≥ 16 lymph node yield, (iii) absence of major complications at 90 days, (iv) absence of urinary diversion‐related long‐term sequelae, and (v) absence of clinical recurrence in the first year were considered to have achieved the radical cystectomy‐pentafecta. Results The overall radical cystectomy‐pentafecta achievement rate was 46.2% (46.5% in the neoadjuvant chemotherapy group and 45.3% in the no chemotherapy group). In the neoadjuvant chemotherapy group, patients who achieved the radical cystectomy‐pentafecta demonstrated significantly better overall survival ( p = 0.038), cancer‐specific survival ( p = 0.009), and recurrence‐free survival ( p < 0.001) than those who did not. Conclusions The radical cystectomy‐pentafecta is a valuable tool to assess the quality of robot‐assisted radical cystectomy with intracorporeal urinary diversion. Its achievement may be associated with improved outcomes in patients with muscle‐invasive bladder cancer undergoing neoadjuvant chemotherapy prior to surgery.