Washington, DC (UroToday.com) Following Dr. Parekh’s presentation on robotic cystectomy (RALRC), Dr. Bernard Bochner presented data in favor of open radical cystectomy (ORC) in today’s bladder cancer debate. He opened by declaring the poor state of current evidence, with 70 total publications on the topic, of which 23 have comparative data, and the majority are comprised of level 4 evidence. Despite this, the data demonstrates a high complication rates all around:
59% 90 day complication rates in RALRC with extracorporeal conduits, and 72% with extracorporeal continent diversions, of which almost ¼ of these are high grade. Dr. Bochner and colleagues designed a study to compare complications in each arm, and this demonstrated no difference in complications or length of stay between ORC and RALRC. Lower blood loss and transfusion requirements were seen with RALRC, and both approaches had similar pathologic outcomes.
Regarding cancer outcomes, nonrandomized comparisons show bias toward treatment of early stage disease in RALRC. Meanwhile, up to 50% of patients in the open series demonstrate extravesical disease. Data from Cornell demonstrated that RALRC has 23% extrapelvic node recurrence (vs 15% in open), and a 2.5-fold increased risk of peritoneal carcinomatosis. Perhaps most importantly, follow-up is much shorter in the robotic arm. Conclusions drawn thus far are not valid until the data matures.
Finally, Dr. Bochner closed with data on the significant cost disadvantage for RALRC. He quoted a $4000 difference in neobladders, and a $1700 difference for conduits.
Dr. Bernard Bochner, MD
Memorial Sloan Kettering Cancer Center
Dr. Nikhil Waingankar, MD. from the Society of Urologic Oncology Meeting - December 2 - 4, 2015 – Washington, DC.
Fox Chase Cancer Center, Philadelphia, PA.