Comparison of Robot-Assisted and Open Radical Cystectomy in Recovery of Patient-Reported and Performance-Related Measures of Independence

Abstract

IMPORTANCENo data exist on time to recovery of patient-reported and performance-related measures of functional independence after radical cystectomy (open or robotic). OBJECTIVE To determine recovery of functional independence after radical cystectomy and whether robot-assisted radical cystectomy (RARC) is associated with any advantage over open procedures. DESIGN, SETTING, AND PARTICIPANTS Data for this secondary analysis from the RAZOR (Randomized Open vs Robotic Cystectomy) trial were used. RAZOR was a phase 3 multicenter noninferiority trial across 15 academic medical centers in the US from July 1, 2011, to November 18, 2014, with a median follow-up of 2 years. Participants included the per-protocol population (n = 302). Data were analyzed from February 1, 2017, to May 1, 2021. INTERVENTIONS Robot-assisted radical cystectomy or open radical cystectomy (ORC). MAIN OUTCOMES AND MEASURES Patient-reported (activities of daily living [ADL] and independent ADL [iADL]) and performance-related (hand grip strength [HGS] and Timed Up & Go walking test [TUGWT]) measures of independence were assessed. Patterns of postoperative recovery for the entire cohort and comparisons between RARC and ORC were performed. Exploratory analyses to assess measures of independence across diversion type and to determine whether baseline impairments were associated with 90-day complications or 1-year mortality were performed. FINDINGS Of the 302 patients included in the analysis (254 men [84.1%]; mean [SD] age at consent, 68.0 [9.7] years), 150 underwent RARC and 152 underwent ORC. Baseline characteristics were similar in both groups. For the entire cohort, ADL, iADL, and TUGWT recovered to baseline by 3 postoperative months, whereas HGS recovered by 6 months. There was no difference between RARC and ORC for ADL, iADL, TUGWT, or HGS scores at any time. Activities of daily living recovered 1 month after RARC (mean estimated score, 7.7 [95% CI, 7.3-8.0]) vs 3 months after ORC (mean estimated score, 7.5 [95% CI, 7.2-7.8]). Hand grip strength recovered by 3 months after RARC (mean estimated HGS, 29.0 [95% CI, 26.3-31.7] kg) vs 6 months after ORC (mean estimated HGS, 31.2 [95% CI,] kg). In the RARC group, 32 of 90 patients (35.6%) showed a recovery in HGS at 3 months vs 32 of 88 (36.4%) in the ORC group (P = .91), indicating a rejection of the primary study hypothesis for HGS. Independent ADL and TUGWT recovered in 3 months for both approaches. Hand grip strength showed earlier recovery in patients undergoing continent urinary diversion (mean HGS at 3 months, 31.3 [95% CI,] vs 33.9 [95% CI, 30.5-37.3] at baseline; P = .09) than (continued) Key Points Question Is robot-assisted radical cystectomy (RARC) associated with faster recovery of patient-reported and performance-related measures of independence when compared with open radical cystectomy (ORC)? Findings This secondary analysis of the RAZOR (Randomized Open vs Robotic Cystectomy) trial found that patients require 3 to 6 months to recover baseline levels of independence irrespective of su...

Robotic radical cystectomy – more precision needed?

“…No difference in surgical complication within 90 days according to the Clavien-Dindo classification were detectable in both groups [4]. In a second analysis, time to recovery to baseline levels not only ranged between 3 and 6 months irrespective of the surgical approach but also revealed a not significant trend towards earlier recovery after RARC [6 ▪▪ ].…”

“…Participants received ORC, RARC+ECUD or a laparoscopic radical cystectomy (LRC). Urinary diversion was established as OBS in 15% in ORC, 10% in RARC and 5% in LRC [6 ▪▪ ]. Relapse-free survival after 5 years ranged from 58 to 71% and hereby revealed no significant differences nor did the overall survival after 5 years [8].…”

“…The RAZOR trial investigated RARC+ECUD vs. ORC in 350 randomly assigned bladder cancer patients [4,5,6 ▪▪ ]. Urinary diversion after RARC and ORC was established as orthotopic bladder substitution (OBS) in 24 and 20% of the patients, respectively [4].…”

Return to work improves quality of life and reduces psychosocial distress after radical cystectomy – data from a contemporary series of 230 German Patients

“…In our study, physical functioning one year after surgery is comparable to normative data from the general German population and therefore corroborates this result. Venkatramani et al showed that there was no difference in the recovery of activities of daily life when comparing patients after robot-assisted RC with patients after conventional RC [23]. As the focus is commonly on global HRQol and physical functioning, additional efforts to also restore role, social, emotional and cognitive functioning are required by healthcare providers.…”

Health-related Quality of Life After Robotic-assisted vs Open Radical Cystectomy: Analysis of a Randomized Trial

“…The RAZOR trial also measured activities of daily living and objective performance measures, but HRQOL assessment was limited to the Functional Assessment of Cancer Therapy–Vanderbilt Cystectomy Index and Short Form 8 Health Survey at 3 and 6 months. 4,5 A recent randomized trial comparing functional and disability measures from 5-26 weeks found evidence of early differences at 5 and 12 weeks, but longer-term HRQOL outcomes and findings for domains such as urinary, bowel, and mental health have not been investigated. 6…”