Robotic cystectomy with intracorporeal urinary diversion evaluated in randomized controlled trial

Robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (i-UD) confers a significant benefit versus the open radical cystectomy technique, according to findings from a prospective randomized trial.1

The authors, led by Riccardo Mastroianni, MD, of the IRCCS “Regina Elena” National Cancer Institute department of urology in Rome, Italy, explained that “To date, all the available RCTs [randomized controlled trials] were characterized by an extracorporeal approach in performing UD…To the best of our knowledge, this is the first RCT aimed at comparing ORC vs RARC with i-UD.”

The study, which was published online in the Journal of Urology, included patients who had undergone a diagnostic transurethral resection of the bladder tumor with cT2-4, cN0, cM0, or recurrent high-grade non–muscle-invasive bladder cancer and had no anesthesiologic contraindications to robotic surgery. The primary end point “was to demonstrate the superiority of RARC with i-UD in terms of a 50% transfusions rate’s reduction,” wrote the authors.

A total of 274 patients were admitted and scheduled for radical cystectomy between January 2018 and September 2020; 96 were excluded due to palliative intent. A further 62 patients denied consent to randomization, leaving 116 consecutive patients who were enrolled in the study. (58 underwent RARC and 58 underwent open radical cystectomy.)

The investigators reported that overall perioperative transfusion rates were significantly lower in patients undergoing RARC (22% vs 41% for open radical cystectomy, P = .046).

“The absolute risk reduction was 19% (95% CI, 2%-36%),” the investigators reported.

Health-related quality of life data were available for 106 patients at 6-month follow-up. Both groups of patients reported significant worsening of physical functioning, role functioning, fatigue, constipation, abdominal bloating and flatulence, body image, and sexual functioning. Patients who underwent open radical cystectomy experienced dyspnea, appetite loss, diarrhea, and urinary symptoms and problems, whereas patients who underwent RARC reported a significant worsening of future perspective.

The investigators noted several limitations to the study, including the fact that it was performed in a single high-volume referral center by surgical teams experienced with the techniques evaluated in the study. They also emphasized the need for longer follow-up in order to evaluate potential differences between the cohorts in terms of oncologic and functional outcomes.

Reference

1. Mastroianni R, Ferriero M, Tuderti G, et al. Open radical cystectomy versus robot-assisted radical cystectomy with intracorporeal urinary diversion: early outcomes of a single center randomised controlled trial. J Urol. Published online January 5, 2022. doi:10.1097/JU.0000000000002422