Guidelines recommend radical cystectomy with pelvic lymphadenectomy for aggressive bladder cancer, which is a complex procedure with an estimated 33,429 operations performed in the US from 2008 to 2011 and 3,043 in England in 2015.
Survival following radical cystectomy reflects tumor biology, treatment received, and patient fitness. Morbidity from complications after cystectomy can be considerable. Most patients develop 1 or more complications; 20% require intervention after radical cystectomy, and 20% to 30% are readmitted after discharge.
In a recently published study, researchers at UCL and the University of Sheffield evaluated the use of robot-assisted surgery to perform bladder cancer removal, a radical cystectomy with intracorporeal reconstruction, and compared the procedure with an open radical cystectomy. The study results appear in the journal JAMA Network.
The clinical trial included 338 patients with nonmetastatic bladder cancer recruited at 9 sites in the UK, from March 2017 to March 2020. The patients were randomized to receive robot-assisted radical cystectomy or an open one.
The robot-assisted surgery allows surgeons to guide minimally invasive instruments remotely using a console and aided by a 3D view.
The team found a significant reduction in complications such as blood clots in patients receiving the robotic surgery, patients had a 20% shorter hospital stay (8 days vs 10 days), and readmission to the hospital within 90 days was also reduced significantly (21% for robotic surgery vs 32% for open).
Further evaluations, 90 days post-surgery showed that blood clot prevalence wound complications, disability, quality of life, activity levels, and survival were improved.
James W. F. Catto, et al. Effect of Robot-Assisted Radical Cystectomy With Intracorporeal Urinary Diversion vs Open Radical Cystectomy on 90-Day Morbidity and Mortality Among Patients With Bladder Cancer. JAMA, 2022; DOI: 10.1001/jama.2022.7393