Jul 12 2018
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According to a breakthrough research reported in the journal Lancet, robotic surgery is as effective as traditional open surgery in treating bladder cancer.
The study’s co-authors are three Loyola Medicine urologists, Marcus Quek, MD, Gopal Gupta, MD, and Alex Gorbonos, MD. The First author of the study is Dipen Parekh, MD, of the University of Miami.
Loyola is among 15 centers that took part in the national trial of 350 patients, who were randomly scheduled to undergo an open surgery or robotic surgery to remove cancerous bladders.
When assessed two years later, there was no major difference between the two groups in survival without disease progression. With robotic surgery, there was less blood loss and shorter hospital stays, but surgeries were longer. There were no substantial differences in complication rates or in the quality of life of patients. The study is referred to as RAZOR (randomized open versus robotic cystectomy trial) and was sponsored by the National Cancer Institute.
A surgeon is able to perform operations through tiny incisions using the robotic system. Movements by the surgeon's wrist or hand are translated into extremely precise movements of the surgical instruments. The surgeon directs all maneuvers, in real time, as he/she views a magnified, 3D, high-definition image of the surgical area.
Introduced in 2000, robotic surgery has spread fast and has been used in nearly four million surgeries around the world. But besides the RAZOR trial, there have been no potential, randomized multicenter trials to evaluate how robotic surgery compares to open surgery with regards to cancer survival.
The RAZOR trial showed that two years after surgery, 72.3% of patients in the robotic surgery group were alive, with no disease progression and, in essence, cured, compared with 71.6% in the open surgery group. Among the robotic surgery patients, 67% experienced adverse effects such as intestinal obstructions and urinary tract infections, compared with 69% in the open surgery group.
The robotic surgery group stayed an average of six days in the hospital, compared to the seven days the open surgery group had to remain in hospital. It was observed that robotic surgery patients lost less than half as much blood as open surgery patients, however, spent more time in the operating room — seven hours, eight minutes compared with six hours, one minute.
The scientists wrote that the findings "underscore the need for further high-quality trials to assess surgical innovation before this surgical technique is widely adopted in clinical practice."
Dr. Gupta added that the research offers evidence confirming that the robotic method performs at least as well as the open approach.
It is important to conduct these trials before widespread adoption of technology, as has been the case with robotic prostatectomy (removal of the prostate).
Gopal Gupta, Urologists, Loyola Medicine