In patients with non-metastatic bladder cancer, robotic-assisted radical cystectomy with intracorporeal urine diversion resulted in a statistically significant increase in the number of days alive and out of hospital over a 90-day period relative to open radical cystectomy. However, the differences between the groups were small.
Of the 338 randomized participants, 317 underwent radical cystectomy (mean age 69 years; 21% female); the primary outcome measure was analyzed in 305 patients (96%). The median number of days alive and out of hospital within 90 days of surgery was 82 (IQR 76-84) for patients undergoing robotic surgery and 80 (IQR 72-83) for the group undergoing open surgery (adjusted difference: 2, 2 days, 95% CI 0.50-3.85, p = 0.01). 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) occurred less frequently after robotic surgery than after open surgery. Participants undergoing open surgery reported a 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 = 0.003) 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 = 0.003) and after 12 weeks (difference: 0.38; 95% CI 0.09-0.68, p = 0.01); the differences were not significant after >12 weeks. There were no statistically significant differences in recurrence rate and all-cause mortality after a median follow-up of 18.4 months.
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Catto JW, Khetrapal P, Ricciardi F, 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: A Randomized Clinical Trial. JAMA. 2022 May 15. Online ahead of print.