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July 12, 2018

Open surgery as effective as robotic for bladder cancer, study finds

The US-based randomised open versus robotic cystectomy (RAZOR) trial has found robotic surgery to be just as effective as traditional open surgery when treating bladder cancer.

By Charlotte Edwards

The US-based randomised open versus robotic cystectomy (RAZOR) trial has found robotic surgery to be just as effective as traditional open surgery when treating bladder cancer.

Published in the journal Lancet, the study involved the participation of 15 medical centres and 350 patients, randomly assigned to either robotic surgery or open surgery to remove cancerous bladders. It was funded by the National Cancer Institute and is the first prospective, randomised multicentre trial to assess how robotic surgery compares to open surgery in cancer survival.

The University of Miami’s Dr Dipen Parekh is the first author of the study and three Loyola Medicine urologists, Dr Marcus Quek, Dr Gopal Gupta and Dr Alex Gorbonos, are co-authors.

The study found no significant difference between patients who had robot surgery compared to open surgery after a two-year period. Robotic surgery was linked to less blood loss and shorter hospital stays but had longer surgery times. No significant difference in complication rates or in patient quality of life was found.

Two years after surgery, 72.3% of patients in the robotic surgery group were alive and displaying no signs of disease progression, compared with 71.6% in the open surgery group. Of the robotic surgery patients, 67% experienced adverse effects such as urinary tract infections and intestinal obstructions, compared with 69% in the open surgery group.

On average, robotic surgery patients had a six-day stay in hospital, compared with seven days for the open surgery group. Robotic surgery patients lost less than half as much blood as open surgery patients but spent more time in the operating room.

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Gupta said that the study provided evidence that a robotic approach can work at least as well as an open approach. He added: “It is important to conduct these trials before widespread adoption of technology, as has been the case with robotic prostatectomy.”

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