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Platinum Priority – Bladder Cancer – Editor's Choice Editorial by Bertram Yuh, Kevin Chan and Timothy Wilson on pp. 472–473 of this issue| Volume 74, ISSUE 4, P465-471, October 01, 2018

Randomized Trial Comparing Open Radical Cystectomy and Robot-assisted Laparoscopic Radical Cystectomy: Oncologic Outcomes

  • Bernard H. Bochner
    Correspondence
    Corresponding author. Sidney Kimmel Center for Prostate and Urologic Cancers, Memorial Sloan Kettering Cancer Center, 353 E. 68th Street, New York, NY 10065, USA. Tel. +646 422 4387; Fax: +212 919 0759.
    Affiliations
    Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Department of Urology, Weill Cornell Medical College, New York, NY, USA
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  • Guido Dalbagni
    Affiliations
    Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Department of Urology, Weill Cornell Medical College, New York, NY, USA
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  • Karim H. Marzouk
    Affiliations
    Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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  • Daniel D. Sjoberg
    Affiliations
    Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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  • Author Footnotes
    1 Current affiliation: Division of Urology, Department of Surgery, Lions Gate Hospital, North Vancouver, BC, Canada.
    Justin Lee
    Footnotes
    1 Current affiliation: Division of Urology, Department of Surgery, Lions Gate Hospital, North Vancouver, BC, Canada.
    Affiliations
    Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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  • Sheri M. Donat
    Affiliations
    Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Department of Urology, Weill Cornell Medical College, New York, NY, USA
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  • Jonathan A. Coleman
    Affiliations
    Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Department of Urology, Weill Cornell Medical College, New York, NY, USA
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  • Andrew Vickers
    Affiliations
    Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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  • Harry W. Herr
    Affiliations
    Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Department of Urology, Weill Cornell Medical College, New York, NY, USA
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  • Vincent P. Laudone
    Affiliations
    Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Department of Urology, Weill Cornell Medical College, New York, NY, USA
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  • Author Footnotes
    1 Current affiliation: Division of Urology, Department of Surgery, Lions Gate Hospital, North Vancouver, BC, Canada.

      Abstract

      Background

      Open radical cystectomy (ORC) has proven to be an important component in the treatment of high-risk bladder cancer (BCa). ORC surgical morbidity remains high; therefore, minimally invasive surgical techniques have been introduced in an attempt to improve patient outcomes.

      Objective

      To compare cancer outcomes in BCa patients managed with ORC or robotic-assisted radical cystectomy (RARC).

      Design, setting, and participants

      A prospective, randomized trial was completed between 2010 and 2013. Patients were randomized to ORC/pelvic lymphadenectomy (PLND) or RARC/PLND, with all undergoing open/extracorporeal urinary diversion. Median follow-up was 4.9 (IQR: 3.9–5.9) yr after surgery among surviving patients.

      Outcome measurements and statistical analysis

      Secondary outcomes to the trial included recurrence-free, cancer-specific, and overall survival.

      Results and limitations

      The trial randomized 118 patients who underwent RC/PLND and urinary diversion. Sixty were randomized to RARC and 58 to ORC. Four RARC-assigned patients refused randomization and received ORC; however, an intention to treat analysis was performed. No differences were observed in recurrence (hazard ratio [HR]: 1.27; 95% confidence interval [CI]: 0.69–2.36; p = 0.4) or cancer-specific survival (p = 0.4). No difference in overall survival was observed (p = 0.8). However, the pattern of first recurrence demonstrated a nonstatistically significant increase in metastatic sites for those undergoing ORC (sub-HR [sHR]: 2.21; 95% CI: 0.96–5.12; p = 0.064) and a greater number of local/abdominal sites in the RARC-treated patients (sHR: 0.34; 95% CI: 0.12–0.93; p = 0.035). The major limitation to this study is that the trial was not powered to determine differences in cancer recurrences, survival outcomes, or patterns of recurrence.

      Conclusions

      The secondary outcomes from our randomized trial did not definitively demonstrate differences in cancer outcomes in patients treated with ORC or RARC. However, differences in observed patterns of first recurrence highlight the need for future studies.

      Patient summary

      Of 118 patients randomly assigned to undergo radical cystectomy/pelvic lymphadenectomy and urinary diversion, half were assigned to open surgery and half to robot-assisted techniques. We found no difference in risk of recurring or dying of bladder cancer between the two groups.

      Keywords

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