Health-related Quality of Life Outcomes After Robot-assisted and Open Radical Cystectomy Using a Validated Bladder-specific Instrument: A Multi-institutional Study

Aboumohamed, Ahmed; Raza, Syed Johar; Al-Daghmin, Ali; Tallman, Christopher; Creighton, Terrance; Crossley, Heather; Dailey, Stephen; Khan, Aabroo; Din, Rakeeba; Mehedint, Diana; Wang, Katy; Shi, Yi; Sharif, Mohamed; Wilding, Gregory E.; Weizer, Alon Z.; Guru, Khurshid A.

doi:10.1016/j.urology.2014.02.024

Cited by 36 publications

(22 citation statements)

References 17 publications

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“…In NRCTs (Table ), Aboumohamed et al . compared health‐related QOL between the RARC and ORC in 182 patients preoperatively, and at 1, 3, 6, 12, 18, 24 and 30 months postoperatively utilizing BCI and the European Organization for Research and Treatment of Cancer BIS questionnaires . They reported that the BCI and BIS scores were not statistically different between the RARC and ORC arms at any time point for urinary function ( P = 0.11), bowel function ( P = 0.58) and body image ( P = 0.93), but the sexual function at all time points was better for patients treated with ORC ( P = 0.047).…”

Section: Resultsmentioning

confidence: 99%

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Comparison of perioperative complications and health‐related quality of life between robot‐assisted and open radical cystectomy: A systematic review and meta‐analysis

et al. 2019

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To compare postoperative complications and health‐related quality of life of patients undergoing robot‐assisted radical cystectomy with those of patients undergoing open radical cystectomy. A systematic search was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement. A pooled meta‐analysis was carried out to assess the differences between robot‐assisted radical cystectomy and open radical cystectomy according to randomized and non‐randomized comparative studies, respectively. We identified six randomized comparative studies and 31 non‐randomized comparative studies. Most robot‐assisted radical cystectomy patients were treated with extracorporeal urinary diversion. Robot‐assisted radical cystectomy was associated with longer operative times, and lower blood loss and transfusion rates compared with open radical cystectomy in both randomized comparative studies and non‐randomized comparative studies. There was no significant difference between robot‐assisted radical cystectomy and open radical cystectomy in the rate of patients with any or major complications within 90 days both in randomized comparative studies and non‐randomized comparative studies. Non‐randomized comparative studies reported a lower rate of complications at 30 days, mortality at 90 days and length of stay for patients treated with robot‐assisted radical cystectomy, which were not confirmed in randomized comparative studies. Additionally, there were no differences in postoperative quality of life score assessment at 3 and 6 months between robot‐assisted radical cystectomy and open radical cystectomy. Robot‐assisted radical cystectomy is associated with less blood loss and lower transfusion rates. There is no difference in complications, length of stay, mortality, and quality of life between robot‐assisted radical cystectomy and open radical cystectomy. Data from non‐randomized comparative studies favor perioperative outcomes in robot‐assisted radical cystectomy patients, the failure to confirm in randomized comparative studies, likely due to bias in study design and reporting. Further randomized comparative studies comparing postoperative complications and quality of life between robot‐assisted radical cystectomy with intracorporeal urinary diversion and open radical cystectomy are required to assess potential differences between these two surgical approaches.

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Section: Resultsmentioning

confidence: 99%

“…The general characteristics of the eligible studies are summarized in Table . The present systematic review includes six RCTs comprising 581 patients, and 31 NRCTs comprising 48 392 patients published between 2010 and 2018. Of these, 20 studies enrolled patients from North America, nine from Europe and eight from Asia.…”

Section: Resultsmentioning

confidence: 99%

Comparison of perioperative complications and health‐related quality of life between robot‐assisted and open radical cystectomy: A systematic review and meta‐analysis

et al. 2019

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“… 9 Changes in health-related quality of life in patients treated with radical cystectomy and urinary diversion, with regard to urinary, bowel, and sexual functions, as well as body image perception, can be prolonged and dramatic. 10 Therefore, the identification of biomarkers that predict the prognosis of TCC is crucial.…”

Section: Discussionmentioning

confidence: 99%

The expression sequence tag is an effective method for screening DNA segments that predict urinary bladder transitional cell carcinoma prognosis

Yang

Hsu

Lin

et al. 2014

OTT

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PurposeWe validated the use of expression sequence tags (ESTs) as an effective method of screening for DNA segments that could predict urothelial cell carcinoma and for identifying ESTs with such predictive value.Patients and methodsFrom 2004 to 2009, eleven patients were enrolled in this study: six with high-grade bladder carcinoma and five with low-grade bladder carcinoma. ESTs were used to screen for differential gene expression in a high-grade cell line (MGH-U1) and in a premalignant cell line (MGH-U4). Immunohistochemistry and real-time reverse transcription-polymerase chain reaction were used to validate the degree of EST expression and the prognostic value of ESTs.ResultsApoferritin H subunit (FTH1 protein) exhibited increased expression in high-grade bladder carcinoma compared with that seen in low-grade carcinoma. Immunohistochemistry and real-time reverse transcription-polymerase chain reaction both supported the higher expression of FTH1 in high-grade urothelial carcinoma.ConclusionESTs are useful for detecting the FTH1 protein, which predicts the prognosis of patients with bladder carcinoma.

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“…RARC has comparable health-related quality of life (HRQL) outcomes to ORC [12]. Comparisons of diversion techniques (ECUD vs. ICUD) showed similar findings in baseline and postoperative HRQL with no significant differences in body image domains [12]. Oncological, functional and complications following RARC with total intracorporeal neobladder were also reported similar to that of open procedure [13].…”

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confidence: 82%

“…Although patients in the ICUD group have marginally longer hospital stay but no difference in the reoperation rates at 30 days and complications rate at 90 days was observed. RARC has comparable health-related quality of life (HRQL) outcomes to ORC [12]. Comparisons of diversion techniques (ECUD vs. ICUD) showed similar findings in baseline and postoperative HRQL with no significant differences in body image domains [12].…”

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confidence: 98%

Robotic Assisted Radical Cystectomy, Current Status and Future Directions

Ahmad¹

2015

Med Surg Urol

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Advancement in technological front paves the pathway for development of new surgical techniques. These new techniques continuously challenge the established "gold standards". Robotic assisted minimal invasive surgery is one of these advancements of present era. New medical gadgets are fascinating but a careful evidence based approach is needed before adopting these innovations in clinical practice.Open radical cystectomy (ORC) is still considered as a standard procedure for muscle invasive bladder cancer however, Robotic assisted radical cystectomy (RARC) is gaining popularity [1,2]. Before general acceptability, like any other new procedure, RARC is required to answer important issues. First, is this a safe procedure? Second, can it provide same or better oncological and functional outcomes as compared to ORC? Third, can it reduce intraoperative/postoperative complications and can it improve survival?All of these questions have been assessed and reported in literature, but the strength of evidence is somewhat immature in few areas. Recent publications [3][4][5] and consensus from Pasadena conference of world experts in Radical cystectomy have covered many areas regarding this rapidly evolving urological procedure. Overall, these publications provided a supportive comprehensive review of the literature covering various aspects of RARC. Although, definitive comparisons of oncological and functional outcomes between ORC and RARC are lacking, early results appear comparable [4]. Bochner et al. [2] reported similar rates of perioperative complications and lengths of hospital stay among ORC and RARC. However, blood loss was significantly lower in RARC group but high-grade complications were not statistically different. Importantly, pathologic variables e.g. positive surgical margins and lymph node yields were similar in both ORC and RARC [6]. Likewise, three and six month's quality of life (QOL) outcomes were equal. However, RARC was found to be more expansive than ORC on cost analysis [6]. Safety issues relating to RARC have been reported in a meta-analysis [7] comparing RARC and ORC. In contract to Bochner et al. data, this analysis showed a statistically significant lower incidence of high grade complications in RARC cohort. While operating time was significantly higher in the RARC group. However, difference in mortality, positive margin rate, overall and lower grade complications between the two cohorts didn't achieve statistical significance [7]. Long-term survival outcomes for RARC are also noted to be similar to ORC [8]. Khan et al. [9] showed an overall survival of 64%, disease-specific survival of 75%, and disease-free survival of 50% after RARC at minimum of 5 years follow up. Furthermore, RARC is not known to act as an independent predictor of recurrence [10].There has been much debate on the suitable approach for urinary diversion (intracorporeal or extracorporeal) following RARC. Intracorporeal urinary diversion (ICUD) has the potential advantages of a small incision, decreased bowel exposure and less ...

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Health-related Quality of Life Outcomes After Robot-assisted and Open Radical Cystectomy Using a Validated Bladder-specific Instrument: A Multi-institutional Study

Cited by 36 publications

References 17 publications

Comparison of perioperative complications and health‐related quality of life between robot‐assisted and open radical cystectomy: A systematic review and meta‐analysis

Comparison of perioperative complications and health‐related quality of life between robot‐assisted and open radical cystectomy: A systematic review and meta‐analysis

The expression sequence tag is an effective method for screening DNA segments that predict urinary bladder transitional cell carcinoma prognosis

Robotic Assisted Radical Cystectomy, Current Status and Future Directions

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