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Perioperative Outcomes and Oncologic Efficacy from a Pilot Prospective Randomized Clinical Trial of Open Versus Robotic Assisted Radical Cystectomy

2012; Lippincott Williams & Wilkins; Volume: 189; Issue: 2 Linguagem: Inglês

10.1016/j.juro.2012.09.077

1527-3792

Dipen J. Parekh, Jamie Messer, John FitzGerald, Barbara Ercole, Robert S. Svatek,

Urological Disorders and Treatments

No AccessJournal of UrologyAdult Urology1 Feb 2013Perioperative Outcomes and Oncologic Efficacy from a Pilot Prospective Randomized Clinical Trial of Open Versus Robotic Assisted Radical Cystectomy Dipen J. Parekh, Jamie Messer, John Fitzgerald, Barbara Ercole, and Robert Svatek Dipen J. ParekhDipen J. Parekh , Jamie MesserJamie Messer , John FitzgeraldJohn Fitzgerald , Barbara ErcoleBarbara Ercole , and Robert SvatekRobert Svatek View All Author Informationhttps://doi.org/10.1016/j.juro.2012.09.077AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Robotic assisted laparoscopic radical cystectomy for bladder cancer has been reported with potential for improvement in perioperative morbidity compared to the open approach. However, most studies are retrospective with significant selection bias. Materials and Methods: A pilot prospective randomized trial evaluating perioperative outcomes and oncologic efficacy of open vs robotic assisted laparoscopic radical cystectomy for consecutive patients was performed from July 2009 to June 2011. Results: To date 47 patients have been randomized with data available on 40 patients for analysis. Each group was similar with regard to age, gender, race, body mass index and comorbidities, as well as previous surgeries, operative time, postoperative complications and final pathological stage. We observed no significant differences between oncologic outcomes of positive margins (5% each, p = 0.50) or number of lymph nodes removed for open radical cystectomy (23, IQR 15–28) vs robotic assisted laparoscopic radical cystectomy (11, IQR 8.75–21.5) groups (p = 0.135). The robotic assisted laparoscopic radical cystectomy group (400 ml, IQR 300–762.5) was noted to have decreased estimated blood loss compared to the open radical cystectomy group (800 ml, IQR 400–1,100) and trended toward a decreased rate of excessive length of stay (greater than 5 days) (65% vs 90%, p = 0.11) compared to the open radical cystectomy group. The robotic group also trended toward fewer transfusions (40% vs 50%, p = 0.26). Conclusions: Our study validates the concept of randomizing patients with bladder cancer undergoing radical cystectomy to an open or robotic approach. Our results suggest no significant differences in surrogates of oncologic efficacy. Robotic assisted laparoscopic radical cystectomy demonstrates potential benefits of decreased estimated blood loss and decreased hospital stay compared to open radical cystectomy. Our results need to be validated in a larger multicenter prospective randomized clinical trial. References 1 : Cancer statistics, 2012. 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Google Scholar Department of Urology, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas© 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited BySathianathen N, Kalapara A, Frydenberg M, Lawrentschuk N, Weight C, Parekh D and Konety B (2018) Robotic Assisted Radical Cystectomy vs Open Radical Cystectomy: Systematic Review and Meta-AnalysisJournal of Urology, VOL. 201, NO. 4, (715-720), Online publication date: 1-Apr-2019.Hussein A, Elsayed A, Aldhaam N, Jing Z, Osei J, Kaouk J, Redorta J, Menon M, Peabody J, Dasgupta P, Khan M, Mottrie A, Stöckle M, Hemal A, Richstone L, Hosseini A, Wiklund P, Schanne F, Kim E, Ho Rha K and Guru K (2019) Ten-Year Oncologic Outcomes Following Robot-Assisted Radical Cystectomy: Results from the International Robotic Cystectomy ConsortiumJournal of Urology, VOL. 202, NO. 5, (927-935), Online publication date: 1-Nov-2019.Chang S (2018) Re: Oncologic Outcomes following Robot-Assisted Radical Cystectomy with Minimum 5-Year Follow-up: The Roswell Park Cancer Institute ExperienceJournal of Urology, VOL. 195, NO. 5, (1381-1382), Online publication date: 1-May-2016.Nguyen D, Al Hussein Al Awamlh B, O'Malley P, Khan F, Lewicki P, Golombos D and Scherr D (2018) Factors Impacting the Occurrence of Local, Distant and Atypical Recurrences after Robot-Assisted Radical Cystectomy: A Detailed Analysis of 310 PatientsJournal of Urology, VOL. 196, NO. 5, (1390-1396), Online publication date: 1-Nov-2016.Lau C, Blackwell R and Quek M (2018) Radical Cystectomy: Open vs Robotic ApproachJournal of Urology, VOL. 193, NO. 2, (400-402), Online publication date: 1-Feb-2015.Desai M, Gill I, de Castro Abreu A, Hosseini A, Nyberg T, Adding C, Laurin O, Collins J, Miranda G, Goh A, Aron M and Wiklund P (2018) Robotic Intracorporeal Orthotopic Neobladder during Radical Cystectomy in 132 PatientsJournal of Urology, VOL. 192, NO. 6, (1734-1740), Online publication date: 1-Dec-2014.Hautmann R, Herr H, Pruthi R and Aron M (2018) Robotic Radical Cystectomy—Is the Diversion the Achilles' Heel?Journal of Urology, VOL. 192, NO. 6, (1601-1603), Online publication date: 1-Dec-2014.Deibert C, Berg W, Cha D and Gupta M (2018) Preliminary Evaluation of the endogo® HD Portable Cystoscopic CameraUrology Practice, VOL. 1, NO. 2, (100-103), Online publication date: 1-Jul-2014.Steers W (2018) This Month in Adult UrologyJournal of Urology, VOL. 189, NO. 2, (405-406), Online publication date: 1-Feb-2013. Volume 189Issue 2February 2013Page: 474-479 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.Keywordslaparoscopycystectomyurinary bladder neoplasmsroboticsrandomized controlled trialMetricsAuthor Information Dipen J. Parekh More articles by this author Jamie Messer More articles by this author John Fitzgerald More articles by this author Barbara Ercole More articles by this author Robert Svatek More articles by this author Expand All Advertisement PDF DownloadLoading ...