Newswise — June 17, 2020 – For patients with bladder cancer, health-related quality of life (HRQoL) outcomes are similar after high-tech robot-assisted surgery compared to conventional open surgery, reports The Journal of Urology®, Official Journal of the American Urological Association (AUA). The journal is published in the Lippincott portfolio by Wolters Kluwer.
While robot-assisted cystectomy surgery is an increasingly popular option for treatment of bladder cancer, key physical and mental health outcomes are about the same as those of conventional cystectomy, according to the new study by Dipen J. Parekh, MD, of University of Miami Miller School of Medicine and colleagues. “As robotic procedures become more widespread it is important to discuss this finding during counseling,” the researchers write.
Robotic or Open, Surgery for Bladder Cancer Improves Quality of Life
The study included participants from a previous study in which patients with invasive bladder cancer were randomly assigned to one of two approaches for cystectomy (surgery to remove the bladder). One group underwent robot-assisted cystectomy, while the other group underwent conventional open cystectomy. The main study results showed similar control of bladder cancer with both procedures.
This new analysis compared the two groups on measures of physical and mental health and functioning. In addition to a standard general HRQoL assessment (SF-8), patients were assessed on a questionnaire addressing specific concerns after cystectomy for bladder cancer (FACT-VCI). Three hundred two patients completed HRQoL assessments up to six months after robotic or conventional cystectomy.
For the bladder cancer-specific FACT-VCI questionnaire, there were no significant differences reported between the robotic or conventional surgery groups. With both approaches, scores for emotional well-being improved over time.
For the general SF-8 questionnaire, patients undergoing open cystectomy had greater improvement in both the physical and mental aspects of HRQoL, compared to the robotic surgery group. However, the clinical relevance of this finding is unclear; the researchers suggest it might be due to higher expectations for postoperative recovery in patients undergoing robotic surgery.
After cystectomy, patients may undergo the creation of a “neobladder” to allow for relatively normal urination (continent diversion) or the placement of an opening in the abdomen (stoma) to allow urine to be drained. On the FACT questionnaire, patients undergoing continent diversion had lower HRQoL scores at three months, but not six months. On the SF-8, continent-diversion patients had better scores for physical health at 6 months.
While robot-assisted cystectomy offers some advantages – such as reduced blood loss and shorter hospital stay – control of bladder cancer is similar to that after conventional open cystectomy. This new study is the first to compare HRQoL outcomes in patients undergoing these two procedures.
The overall trend toward improvement suggests either robotic or conventional cystectomy leads to improved HRQoL. Surgical treatment for bladder cancer appears to offer symptomatic and physical benefits, in addition to improving patients’ emotional well-being.
At a time of growing interest and high hopes for better outcomes after robotic surgery, the findings may help “to narrow the discrepancy between patients’ expectations and reality, thus empowering patients to make informed decisions,” Dr. Parekh and coauthors write. They conclude: “The lack of significant differences in the health-related quality of life between robotic and open cystectomy should be discussed with patients during counseling and are reassuring as more surgeons become comfortable with robotic surgery and patients are seeking more robotic procedures.”
DOI: 10.1097/JU.0000000000001029
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About The Journal of Urology®
The Official Journal of the American Urological Association (AUA), and the most widely read and highly cited journal in the field, The Journal of Urology® brings solid coverage of the clinically relevant content needed to stay at the forefront of the dynamic field of urology. This premier journal presents investigative studies on critical areas of research and practice, survey articles providing brief editorial comments on the best and most important urology literature worldwide and practice-oriented reports on significant clinical observations. The Journal of Urology® covers the wide scope of urology, including pediatric urology, urologic cancers, renal transplantation, male infertility, urinary tract stones, female urology and neurourology.
About the American Urological Association
Founded in 1902 and headquartered near Baltimore, Maryland, the American Urological Association is a leading advocate for the specialty of urology, and has more than 23,000 members throughout the world. The AUA is a premier urologic association, providing invaluable support to the urologic community as it pursues its mission of fostering the highest standards of urologic care through education, research and the formulation of health care policy. To learn more about the AUA visit: www.auanet.org.
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