For a study, researchers sought to assess recovery and morbidity following robot-assisted radical cystectomy with intracorporeal reconstruction vs. open radical cystectomy.
From March 2017 to March 2020, individuals with nonmetastatic bladder cancer were recruited at 9 locations in the United Kingdom for a randomized clinical study. Follow-ups were performed at 90 days, 6 months, and 12 months, with the last follow-up scheduled for September 23, 2021. The patients were randomly assigned to either robot-assisted radical cystectomy with intracorporeal reconstruction (n=169) or open radical cystectomy (n=169). The primary outcome was the number of days alive and out of the hospital after surgery within 90 days. Complications, quality of life, disability, stamina, activity levels, and survival were among the 20 secondary outcomes. Analyses were modified to account for the kind of diversion and center.
Among the 338 randomized patients, 317 had radical cystectomy (mean age, 69 years; 67 women [21%]; 107 [34%] got neoadjuvant chemotherapy; 282 [89%] underwent ileal conduit reconstruction); the main outcome was examined in 305 (96%). Within 90 days following surgery, the median number of days alive and out of the hospital was 82 (IQR, 76-84) for patients receiving robotic surgery vs. 80 (IQR, 72-83) for patients undergoing open surgery (adjusted difference, 2.2 days [95% CI, 0.50-3.85]; P=.01). Thromboembolic complications (1.9% vs 8.3%; difference, –6.5% [95% CI, –11.4% to –1.4%]) and wound complications (5.6% vs 16.0%; difference, –11.7% [95% CI, –18.6% to –4.6%]) were lower with robotic surgery than with open surgery. Participants undergoing open surgery reported worse quality of life compared to robotic surgery at 5 weeks (difference in mean European Quality of Life 5-Dimension, 5-Level instrument scores, –0.07 [95% CI, –0.11 to –0.03]; P=.003) and greater disability at 5 weeks (difference in World Health Organization Disability Assessment Schedule 2.0 scores, 0.48 [95% CI, 0.15-0.73]; P=.003) and at 12 weeks (difference At a median follow-up of 18.4 months, there were no statistically significant differences in cancer recurrence (29/161 [18%] vs 25/156 [16%] following robotic and open surgery, respectively) or overall mortality (23/161 [14.3%] vs 23/156 [14.7%]) (IQR, 12.8-21.1).
Treatment with robot-assisted radical cystectomy with intracorporeal urinary diversion vs. open radical cystectomy resulted in a statistically significant increase in days alive and out of the hospital over 90 days in patients with nonmetastatic bladder cancer having radical cystectomy. However, the clinical significance of these observations is unknown.