Outcomes of Open Versus Robotic Radical Cystectomy for Bladder Cancer Patients - Expert Commentary

Radical cystectomy continues to be the mainstay curative modality for bladder cancer patients. Understanding the long-term clinical outcomes of robotic and open radical cystectomy is critical for decision making. A recent study published by Venkatramani et al. in The Journal of Urology evaluated the outcomes of open versus robotic radical cystectomy.1 The primary endpoint of the study was the 2-year progression-free survival (PFS). The investigators also assessed the 3-year overall survival (OS), time to recurrence, and 3-year PFS. The authors included the per-protocol populations of 302 patients from the RAZOR study. Of those, 150 patients underwent open surgery and 152 patients underwent robotic surgery.


The study found that the PFS and OS at 36 months were not significantly different between the open and robotic surgical approaches. The PFS at 36 months in the open radical cystectomy group was 65.4% (95% CI 56.8-72.7) and 68.4% (95% CI 60.1-75.3) in the robotic cystectomy group (p=0.6). At 36 months, OS in the robotic group was 73.9% (95% confidence interval [CI] 65.5- 80.5) and 68.5% (95% CI 59.8-75.7) in the open group (p =0.334). There was no significant difference in the cumulative incidence rates of recurrence (p=0.8). Stage and positive margins were significant predictors of recurrence and progression-free and overall survival. The surgical approach did not predict any of these clinical outcome measures.

Reporting long-term oncologic outcomes from randomized trials is critical for selecting proper treatments. Understanding the biology of the disease and patient-specific factors should be considered in selecting the appropriate approach.

Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine, New York City, New York

Reference:

  1. Venkatramani, Vivek, Isildinha M. Reis, Erik P. Castle, Mark L. Gonzalgo, Michael E. Woods, Robert S. Svatek, Alon Z. Weizer et al. "Predictors of Recurrence, and Progression-Free and Overall Survival following Open versus Robotic Radical Cystectomy: Analysis from the RAZOR Trial with a 3-Year Followup." The Journal of urology (2019): 10-1097.
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