Robotic surgery as effective as open surgery for bladder cancer

MAYWOOD, IL – Robotic surgery is as effective as traditional open surgery in the treatment of bladder cancer, according to a landmark study published in Lancet.

Three Loyola Medicine urologists, Marcus Quek, MD, Gopal Gupta, MD, and Alex Gorbonos, MD, are co-authors of the study. The first author is Dipen Parekh, MD, of the University of Miami.

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Loyola is one of 15 centers that participated in the national trial of 350 patients, who were randomly badigned to undergo robotic surgery or open surgery to remove cancerous bladders.

After two years, there was no significant difference between the two groups in progression-free survival of the disease. Robotic surgery was badociated with less blood loss and shorter hospital stays, but longer surgeries. There were no significant differences in complication rates or in patients' quality of life. The study is called RAZOR (open randomized cystectomy versus robotic cystectomy) and was funded by the National Cancer Institute.

A robotic system allows a surgeon to perform operations with the aid of a few small incisions. The movements of the surgeon's hand or wrist translate into very precise movements of the surgical instruments. Each maneuver is directed by the surgeon, in real time, while the surgeon visualizes an enlarged 3D image of the surgical site.

Since robotic surgery was introduced in 2000, it has spread rapidly and has been used in approximately four million surgeries worldwide. But aside from the RAZOR trial, there has been no prospective, randomized, multicenter trial to evaluate how robotic surgery compares to open surgery in cancer survival.

The RAZOR trial revealed that two years after surgery, 72.3% of patients in the robotic surgery group were alive, without disease progression, and essentially cured, compared with 71.6% in the group. open surgery. Sixty-seven percent of robotic surgery patients experienced adverse events such as urinary tract infections and intestinal obstructions, compared to 69 percent in the open surgery group.

Patients in robotic surgery stayed six days in the hospital, compared with seven days in the open surgery group. Patients in robotic surgery lost less than half of the blood than patients operated on in the open, but spent more time in the operating room (seven hours, eight minutes compared to six hours, one minute).

The researchers wrote that the results [traduction] "underscore the need to perform other high-quality trials to evaluate surgical innovation before this surgical technique is widely adopted in practice. clinical".