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Robot-assisted radical cystectomy comparable to open cystectomy for urologic cancers

Dr. Joseph Delano Fule Robles
22 Feb 2019
Dr Eddie Chan

Studies have demonstrated that robot-assisted radical cystectomy (RARC) is as effective and has a cost advantage compared with open cystectomy for the management of urologic cancers.

“As a surgeon, I appreciate the elegance of open surgery, but recent data suggest advantages with robot-assisted surgery, specifically RARC, in terms of reduced blood loss, shortened length of hospital stay and improved bowel recovery. For patients more than 80 years old, RARC is not associated with higher risk of perioperative morbidity and mortality rates compared with open cystectomy,” commented Dr Eddie Chan, President of the Hong Kong Urological Association and Clinical Associate Professor from the Chinese University of Hong Kong (CUHK).

“Radical cystectomy is one of the most technically demanding procedures in urologic surgery, but RARC is even more technically demanding, similar to other minimally invasive surgical procedures [MIS],” Chan added.

In a prospective randomized single-centre study with 41 bladder cancer patients recruited, patients who underwent RARC (n=21) had less blood loss (p<0.0001) and less requirement for analgesia (p<0.005), but a longer operation time (p<0.0001) vs those who underwent open cystectomy (n=20). [Eur Urol 2010;57:196-201]

A prospective study, which involved cost analysis comparing RARC and open cystectomy, showed that operation time and length of hospital stay had the greatest impact on perioperative costs. RARC was shown to have a 38 percent cost advantage due to higher total hospitalization costs for those who underwent open cystectomy in the cohort. [Urology 2011;77:621-625]

RARC also demonstrated noninferiority in terms of 2-year progression-free survival compared with open radical cystectomy (ORC) (72.3 percent vs 71.6 percent) in the open-label, randomized, phase III RAZOR trial. Moreover, no difference in adverse event rates were noted between RARC (67 percent) and ORC (69 percent). [Lancet 2018;391:2525-2536]

A prospective, randomized trial performed in 118 bladder cancer patients compared oncologic outcomes between RARC (n=60) and ORC (n=58). Results showed no differences in recurrence (hazard ratio, 1.27; 95 percent confidence interval, 0.69 to 2.36; p=0.40), cancer-specific survival (p=0.40) and overall survival rates (p=0.80). [Eur Urol 2018;74:465-471]

“Our experience at CUHK [Prince of Wales Hospital] showed that compared with ORC, patients who underwent MIS stayed at the hospital for a shorter period of time [15 days vs 18 days; p=0.049], experienced less blood loss [754 mL vs 1,847 mL; p<0.001], and had a trend towards higher 5-year survival rates [60.7 percent vs 41 percent; p=0.058],” commented Chan.

“CUHK participated in the recent Worldwide Robotic Surgery 24-hour Event [WRSE], which is an online training and learning programme organized by the world’s leading robotic centres and the most experienced surgeons. With this programme, you do not have to travel, and experts will demonstrate actual surgical procedures in real-time,” said Chan. [https://4healthtv.play.livearena.com/sub/wrse/]

“We also offer training courses/programmes at our centre for interested overseas trainees, and established an Asian consortium group for collaboration, data collection, and treatment outcome monitoring in urologic surgery among different centres in the region,” added Chan.

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