Robotic radical cystectomy – more precision needed?

Abstract

Purpose of review Recently, several trials as well as registry-data analyses investigating the role of robot-assisted radical cystectomy with extra or intracorporal urinary diversion were completed and follow up matured. This review aims to comment on the current evidence-based findings and interpret the future role of the robotic approach as a part of the treatment of bladder cancer. Recent findings Numerous trials and registry-data analyses revealed no significant differences in progression-free and overall survival after open radical cystectomy or robot-assisted radical cystectomy irrespective of urinary diversion. Perioperative parameters, especially intraoperative blood loss, transfusions, thromboembolic events, wound infections and hospitalization were significantly increased in open radical cystectomy. Patients’ convalescence, and especially early postsurgical quality of life, was improved by the robotic approach. The highly demanding surgery itself displayed by a flat learning curve required more than 130 surgeries per institution to reach a stable plateau of complications. The performance of high-quality radical cystectomy irrespective of the approach was significantly increased in high-volume centres. Local recurrence occurs in 11% after radical cystectomy. Current research focuses on intraoperatively usable detection methods and instruments to minimize the risk of residual tumour cells. Summary Taken together, the total intracorporal approach in radical cystectomy holds the potential to improve perioperative parameters and reduces hospitalization without impairing oncological performance of the procedure. To provide best results for the patient radical cystectomy and especially the technically challenging total intracorporal procedure will gain importance in bladder cancer treatment but should be limited to high-volume centres.

A Protocol for Organoids from the Urine of Bladder Cancer Patients

“…Treatment regimens for non-muscle-invasive bladder cancer (NMIBC) and muscle-invasive bladder cancer (MIBC) differ. Whereas NMIBC, which accounts for 75% of the newly diagnosed cases, is treated with a transurethral removal of bladder tumor (TURBT), frequently followed by intravesical instillation therapy depending on the risk-stratification, MIBC is commonly treated with a neoadjuvant systemic approach followed by radical cystectomy and urinary diversion [2]. In NMIBC, approximately 70% of patients experience recurrent disease, and around 10-15% of patients progress to MIBC [3].…”