Journal analysis on robot vs open RC.pptx

Journal analysis on robot vs open RC

1. Journal : THE JOURNAL OF UROLOGY Publication date : May, 2023.

2. Introduction Increasing adoption of robotic- assisted laparoscopic radical cystectomy (RARC) for the treatment of muscle invasive bladder cancer. Previous RCT’s comparing RARC with open radical cystectomy (ORC) reported decreased estimated blood loss, but no improvement in perioperative complications, longer operative times, increased costs with RARC. Bochner B, Dalbagni G, Sjoberg D, et al. Comparing open radical cystectomy and robot-assisted l aparo - scopic radical cystectomy: a randomized clinical trial. Eur Urol. 2015;67(6):1042-1050.

3. Introduction Previous trials show short term followup , This is a long term (24 months) detailed comparison analysis of the many functional (urinary, bowel, sexual) and psychosocial areas affected in RC.

4. AIMS To compare health-related quality of life using a broad range of validated measures in patients randomized to robotic-assisted radical cystectomy vs open radical cystectomy.

5. Methods Study Design : RCT Institutions: Single center . Study Period : 2010 to 2013

6. Methods - PICO PICO P opulation MIBC undergoing RC Inclusion Criteria MIBC Consenting 18 years or older, cTa-T3/ cN0-N3, and Non metastatic disease. Exclusion Criteria Not consenting Loss to follow up contraindication for the Trendelenburg position , prior pelvic radiation, or extensive abdominal surgical history Intervention RARC vs ORC , HRQOL assessed preoperatively and at 3, 6, 12, 18, and 24 months postoperatively Outcomes Assesed (1) If mean domain scores differed, and (2) whether the effect of RARC vs ORC varied over time.

7. Methods-Randomization Randomization – randomly permuted blocks. Allocation ratio- 1:1

8. Results 118 patients met the inclusion criteria 28 patients did not enrol, 2 withdrew, 16 did not complete questionnaire. 72 patients analyzed 32 patients in the RARC and 40 patients in the ORC group

9. Baseline Characteristics

10. Outcomes

11. Urostomy Symptoms there was no significant difference over 24 months, but there was evidence of relatively worse symptoms at 3 and 24 months in ORC vs RARC (P < .001).

12. Conclusion It is reasonable to exclude large differences with RARC from 3-24 months. All domains aside from Urostomy Symptoms, did not detect differences. HRQOL over the medium to long term should not be a consideration in choosing between the robotic and open approaches.

13. Critical Analysis Strengths : Used a detailed validated measures to analyze the HRQoL . Limitations : Details of loss to follow up patients not available, Patient deaths and readmissions not described.