Health‐related quality of life from a prospective randomised clinical trial of robot‐assisted laparoscopic vs open radical cystectomy

Abstract

Objective To compare health‐related quality‐of‐life (HRQoL) outcomes for robot‐assisted laparoscopic radical cystectomy (RARC) with those of traditional open radical cystectomy (ORC) in a prospective randomised fashion. Patients and Methods This was a prospective randomised clinical trial evaluating the HRQoL for ORC vs RARC in consecutive patients from July 2009 to June 2011. We administered the Functional Assessment of Cancer Therapy–Vanderbilt Cystectomy Index questionnaire, validated to assess HRQoL, preoperatively and then at 3, 6, 9 and 12 months postoperatively. Scores for each domain and total scores were compared in terms of deviation from preoperative values for both the RARC and the ORC cohorts. Multivariate linear regression was used to assess the association between the type of radical cystectomy and HRQoL. Results At the time of the study, 47 patients had met the inclusion criteria, with 40 patients being randomised for analysis. The cohorts consisted of 20 patients undergoing ORC and 20 undergoing RARC, who were balanced with respect to baseline demographic and clinical features. Univariate analysis showed a return to baseline scores at 3 months postoperatively in all measured domains with no statistically significant difference among the various domains between the RARC and the ORC cohorts. Multivariate analysis showed no difference in HRQoL between the two approaches in any of the various domains, with the exception of a slightly higher physical well‐being score in the RARC group at 6 months. Conclusions There were no significant differences in the HRQoL outcomes between ORC and RARC, with a return of quality of life scores to baseline scores 3 months after radical cystectomy in both cohorts.

Controversies in Robotics: Open Versus Robotic Radical Cystectomy

“…A recent prospective, randomized trial was conducted to evaluate HRQoL outcomes in patients who underwent ORC or RARC, and used the validated Functional Assessment of Cancer Therapy-Vanderbilt Cystectomy Index (FACT-VCI). 24 In their analysis, they found no significant differences in the HRQoL outcomes: specifically, physical well-being, social and/or family, and emotional well-being. In addition, changes in the FACT-VCI were similar across both cohorts at the 3-, 6-, 9-, and 12-month intervals, with a HRQoL return to baseline at 3 months after RC.…”

“…48,52,58 Quality of life studies that compared type of diversion outcomes 59 have been conducted, as have studies that compared approach, 60 but very limited data exist on comparison of types of diversion (continent vs. incontinent) and the approach (ICUD vs. ECUD). 24 Results for ICNB continence are promising. At 12 months, Tyritzis et al reported 88.2% and 88.9% daytime continence and 73.5% and 81.2% nighttime continence in male patients with nerve-sparing and nonnerve-sparing neobladder, respectively.…”

Recent Trends in Postcystectomy Health-related Quality of Life (QoL) Favors Neobladder Diversion: Systematic Review of the Literature

“…An area of developing interest has been in robot-assisted and laparoscopic cystectomy although, to date, no study has yet focussed on comparing QoL outcomes between neobladder and other diversion types in these population groups. 22,[29][30] Conclusions Neobladder has indeed stood the test of time with recent studies predominantly concluding that such a diversion is associated with superior QoL scores than other diversion types. With the advent of minimally invasive techniques and better quality studies it remains to be seen whether these recent trends with neobladder reconstruction can be sustained.…”

Quality of Life after Radical Cystectomy and Diversion

“…Messer ve ark. yaptığı prospektif randomize çalışmada ise robotik ve açık cerrahi karşılatılırmıştır (60). Yirmişer kişilik iki gruba ayrılan hastalara Therapy-Vanderbilt Cystectomy Index sorgulaması ve HRQoL uygulanmıştır.…”