Long-term Oncological Outcomes from an Early Phase Randomised Controlled Three-arm Trial of Open, Robotic, and Laparoscopic Radical Cystectomy (CORAL).

The long-term oncological outcomes of laparoscopic (LRC) and robotic-assisted radical cystectomy (RARC) are still maturing compared with open radical cystectomy (ORC).

To evaluate the 5-yr oncological outcomes of patients recruited into the randomised trial of Open, Laparoscopic and Robot Assisted Cystectomy (CORAL) and extracorporeal urinary diversion.

A review of prospectively maintained database of 60 patients with muscle-invasive bladder cancer (MIBC) or high-risk nonmuscle-invasive bladder cancer (HRNMIBC) who were previously randomised in the CORAL trial to receive ORC, RARC, or LRC. This trial was designed to compare the perioperative and early oncological outcomes of these techniques.

The outcomes of interest included 5-yr recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS). Kaplan-Meier curves were used to plot the recurrence and survival data. The curves between RFS, CSS, and OS were compared using the log-rank test. A two-sided p value <0.05 was considered significant. Results were analysed on the basis of intention to treat.

A total of 60 patients with either MIBC (n=38) or HRNMIBC (n=21) were randomised in the CORAL trial to receive ORC, RARC, or LRC. The 5-yr RFS was 60%, 58%, and 71%; 5-yr CSS was 64%, 68%, and 69%; and 5-yr OS was 55%, 65%, and 61% for ORC, RARC, and LRC, respectively. There was no significant difference in RFS, CSS, and OS between the three surgical arms. The principal limitation is the small sample size.

There was no difference in 5-yr RFS, CSS, and OS rates of patients who underwent ORC, RARC, and LRC for management of bladder cancer. Minimally invasive techniques achieved equivalent oncological outcomes to the gold standard of ORC. However, the study was based at a single institution with a small sample size.

Patients who agreed to participate in the randomised trial of either open, laparoscopic, or robotic-assisted radical cystectomy for bladder cancer did not have different cancer outcomes at 5yr.

European urology. 2019 Nov 15 [Epub ahead of print]

Muhammad Shamim Khan, Kawa Omar, Kamran Ahmed, Christine Gan, Mieke Van Hemelrijck, Rajesh Nair, Ramesh Thurairaja, Peter Rimington, Prokar Dasgupta

Department of Urology, Guy's & St Thomas' NHS Foundation Trust, London, UK; MRC Centre for Transplantation, King's College London, London, UK. Electronic address: ., Department of Urology, Guy's & St Thomas' NHS Foundation Trust, London, UK., MRC Centre for Transplantation, King's College London, London, UK; Department of Urology, King's College Hospital, Denmark Hill, London, UK., King's College London, School of Cancer and Pharmaceutical Studies, Translational Oncology & Urology Research (TOUR), London, UK., Department of Urology, Guy's & St Thomas' NHS Foundation Trust, London, UK; MRC Centre for Transplantation, King's College London, London, UK.