Robotic surgery as effective as open surgery for bladder cancer, says study

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New United States research has found that robotic surgery is just as effective as traditional open surgery for treating bladder cancer.

Directed by Dipen J. Parekh, MD, chair of urology and director of robotic surgery at the University of Miami Miller School of Medicine, the seven-year Randomized Open Versus Robotic Cystectomy (RAZOR) trial is the first major study to compare the outcomes of robotic surgery to those of traditional open surgery in any organ.

Conducted at 15 medical centers across the U.S., the trial looked at 302 patients in the bladder cancer study, 152 of whom received traditional open surgery and 150 who received robotic surgery. Patients were then followed for two to three years after surgery to compare outcomes.

The researchers found that there were no differences in complication rates between the two groups of patients, with adverse events occurring in 67 percent of the robotic group and 69 percent of the open surgery group. In addition, the two-year progression-free survival was nearly the same.

The team found no advantage of one surgery over the other when the two groups were questioned about their quality of life at three and six months after surgery.

“We have done more than four million surgeries with the robotic approach since the device came into existence, and on average we do close to a million robotic surgeries a year globally,” commented Parekh. “No one had followed these patients over a period of time to find out if you are impacting their cancer outcomes with this robotic approach. We were able to prove unequivocally that we are not compromising patient outcomes by using robotic surgery.”

Parekh also added that the most important lesson from the study is that more trials should now be done on other organs. Robotic surgery has become particularly popular with prostate cancer patients, with around 90 percent choosing it, but is also being used in many other organs including kidney, colorectal, OB/GYN and lung cancer.

Some have expressed concern about the lack of tactile feedback in robotic surgery, an important guide for those conducting open surgery, however Parekh explains, “When you do robotic surgery you don’t feel anything. It’s more by visual cues. If you’re doing open surgery you have the organs in your hands, you can feel them, and you assess and do these surgeries accordingly.”

Parekh is highly experienced in performing robotic surgeries with the da Vinci Xi Surgical System, which provides a magnified, three-dimensional view of the organs, and a wide range of motion and flexibility.

The findings can be found published online in the medical journal The Lancet. JB

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