Study results rule out any significant QOL differences after robotic vs open RC, further research needed to confirm results

A recent analysis of data demonstrated that there were no major differences between health-related quality of life (HRQOL) in patients who received robotic-assisted radical cystectomy (RARC) when compared with patients who received open radical cystectomy (ORC). These results were evident in findings presented at the 2021 Society of Urologic Oncology Annual Meeting.¹

Matthew B. Clements, MD

“This study is limited by a small sample size and the fact that it only includes a subset of the overall randomized control trial patients, therefore potentially introducing selection bias,” said Matthew B. Clements, MD, a urologic oncology fellow at Memorial Sloan Kettering Cancer Center, in a presentation of the data. “However, we feel that this study could reasonably exclude a large signal for differences based on operative approach and included a broad variety of quality of life domains.”

The study aimed to compare the 2 cystectomy types—RARC and ORC—over a broader range in a two-year period, due to the fact that previous studies had short postoperative follow-ups of 3-6 months and looked at limited quality of life domains.

To examine this broader range, the researchers analyzed patients with non-metastatic bladder cancer at Memorial Sloan Kettering Cancer Center who received a cystectomy. They focused on a randomized controlled trial comparing RARC and ORC with an open urinary diversion performed in both arms, as well as a prospective study of HRQOL that collected 14 patient-reported outcome measures. These measures were reported at baseline as well as 3-, 6-, 12-, 18-, and 24-months post-RC.

Additionally, longitudinal quality of life was compared in linear mixed-effect models adjusting for baseline scores as well as interaction for study arm by time over 24-months post-op.

Among 118 patients in the randomized controlled trial, 88 participated in the prospective HRQOL study. After excluding for ineligibility, researchers analyzed 72 patients (n = 32 for RARC and n = 40 for ORC).

They found that clinical characteristics between the two arms were generally balanced, but those who received RARC were more likely to be married or partnered and less likely to have received prior pelvic surgery.

There were no major differences in effect based on time of follow-up (aside from social functioning, among which scores were higher in ORC at 12 and 18 months but lower at 24 months [P = .057]); pain, fatigue, appetite, abdominal symptoms (P = .2), or bowel and psychosocial domains. There was higher sexual functioning with patients receiving ORC not meeting traditional significance (P = .055). Body image was similar between groups (P = .6), as well as urinary symptoms and incontinence (P >.5), although some patients with ORC had evidence of lower early symptoms (P = .053, P = .064) based on interaction term.

“These results are hypothesis-generating for larger studies that are needed comparing the approaches, which should also evaluate intracorporeal urinary diversion,” Clements concluded.

Reference

1. Clements, M; Atkinson, T; Dalbagni, G; et al. Health-Related Quality of Life After Robotic-Assisted vs Open Radical Cystectomy: Analysis of a Randomized Trial. Presented at Society of Urologic Oncology 22nd Annual Meeting; Virtual. November 30-December 3, 2021. Abstract 174.