Document Detail


Perioperative outcomes and oncologic efficacy from a pilot prospective randomized clinical trial of open versus robotic assisted radical cystectomy.
MedLine Citation:
PMID:  23017529     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: Robotic assisted laparoscopic radical cystectomy for bladder cancer has been reported with potential for improvement in perioperative morbidity compared to the open approach. However, most studies are retrospective with significant selection bias.
MATERIALS AND METHODS: A pilot prospective randomized trial evaluating perioperative outcomes and oncologic efficacy of open vs robotic assisted laparoscopic radical cystectomy for consecutive patients was performed from July 2009 to June 2011.
RESULTS: To date 47 patients have been randomized with data available on 40 patients for analysis. Each group was similar with regard to age, gender, race, body mass index and comorbidities, as well as previous surgeries, operative time, postoperative complications and final pathological stage. We observed no significant differences between oncologic outcomes of positive margins (5% each, p = 0.50) or number of lymph nodes removed for open radical cystectomy (23, IQR 15-28) vs robotic assisted laparoscopic radical cystectomy (11, IQR 8.75-21.5) groups (p = 0.135). The robotic assisted laparoscopic radical cystectomy group (400 ml, IQR 300-762.5) was noted to have decreased estimated blood loss compared to the open radical cystectomy group (800 ml, IQR 400-1,100) and trended toward a decreased rate of excessive length of stay (greater than 5 days) (65% vs 90%, p = 0.11) compared to the open radical cystectomy group. The robotic group also trended toward fewer transfusions (40% vs 50%, p = 0.26).
CONCLUSIONS: Our study validates the concept of randomizing patients with bladder cancer undergoing radical cystectomy to an open or robotic approach. Our results suggest no significant differences in surrogates of oncologic efficacy. Robotic assisted laparoscopic radical cystectomy demonstrates potential benefits of decreased estimated blood loss and decreased hospital stay compared to open radical cystectomy. Our results need to be validated in a larger multicenter prospective randomized clinical trial.
Authors:
Dipen J Parekh; Jamie Messer; John Fitzgerald; Barbara Ercole; Robert Svatek
Related Documents :
24095039 - Outcomes of endovascular lower extremity interventions depend more on indication than p...
16855169 - Bone metabolism changes during anti-tnf-alpha therapy in patients with active rheumatoi...
21255059 - Randomised clinical trial: delayed-release oral mesalazine 4.8 g/day vs. 2.4 g/day in e...
23230099 - Primary prevention of macroangiopathy in patients with short-duration type 2 diabetes b...
24367649 - Selective laser trabeculoplasty versus argon laser trabeculoplasty in patients with ope...
24526709 - The persistent and broadly modulating effect of inhibitory rtms in nonfluent aphasic pa...
10819819 - Postoperative morbidity in the morbidly obese parturient woman: supraumbilical and low ...
24694519 - In-line hemofiltration minimized extracorporeal membrane oxygenation-related inflammati...
20589639 - Juvenile xanthogranuloma with hematological dysfunction treated with 2cda-arac.
Publication Detail:
Type:  Journal Article; Randomized Controlled Trial     Date:  2012-09-24
Journal Detail:
Title:  The Journal of urology     Volume:  189     ISSN:  1527-3792     ISO Abbreviation:  J. Urol.     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-14     Completed Date:  2013-07-08     Revised Date:  2013-09-05    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  474-9     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2013 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Affiliation:
Department of Urology, University of Texas Health Sciences Center at San Antonio, San Antonio, Texas, USA. parekhd@med.miami.edu
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Aged
Cystectomy / methods*
Female
Humans
Male
Middle Aged
Pilot Projects
Prospective Studies
Robotics*
Treatment Outcome
Urinary Bladder Neoplasms / surgery*
Comments/Corrections
Comment In:
J Urol. 2013 Aug;190(2):811-2   [PMID:  23470225 ]
J Urol. 2013 Aug;190(2):812   [PMID:  23707752 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Trends in the use of incontinence procedures after radical prostatectomy: A population-based analysi...
Next Document:  Circulating obestatin is increased in patients with cardiorenal syndrome and positively correlated w...