Surgeons at 15 medical centers in the US have compared the outcomes of robotic surgery to traditional open surgery for bladder cancer. The 7-year Randomized Open Versus Robotic Cystectomy (RAZOR) trial is the first big study comparing robotic to traditional surgery in any organ. The study found outcomes to be similar for both types of surgery. It was published June 21, 2018 in The Lancet.
The study involved about 300 people with bladder cancer. About half had traditional open surgery to remove their bladders, and the rest had robotic surgery to remove their bladders. In robotic surgery, the doctor sits at a control panel and uses robotic arms to control the instruments. This type of surgery uses smaller incisions, which can help reduce blood loss and allow faster healing and less pain.
The study was designed to measure 2-year, progression-free survival, which means the patients lived for at least 2 years after their diagnosis without their cancer getting worse. It found no significant differences between the 2 groups of people with bladder cancer. After 2 years of follow-up, progression-free survival was 72.3% in the robotic surgery group and 71.6% in the traditional surgery group. The rate of complications was also similar – 67% in the robotic surgery group compared with 69% in the traditional surgery group. The most common complications were urinary tract infection, and a slowdown of movement in the intestines.
In general, patients reported being able to return to their pre-surgery quality of life no matter which type of surgery they received. But in the short term, robotic surgery patients recovered more quickly. They had less bleeding and shorter hospital stays. However, the robotic surgery took longer in the operating room and was more expensive. Robotic surgery requires specialized equipment and training, and may not be available at all hospitals.
Often, new surgical approaches are adopted before randomized trials can be conducted to compare new with existing methods. According to co-author Dipen J.Parekh, MD, the most important lesson from the study is that more trials should be done on robotic vs. traditional surgery, and should include cancers of other organs.
"It is possible to do well-designed Phase 3 multicenter surgical trials comparing new technology and surgical innovations to traditional ones before proclaiming superiority or success of one over the other," he said. "There's a steep cost to robotic technology, and there is a learning curve, so we need to build on this in terms of making rational, data-based decisions."
He also says the study provides evidence patients and doctors can use when making decisions about the best surgery approach for their individual situation.
The American Cancer Society medical and editorial content team
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Citation: Robot-assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer (RAZOR): an open-label, randomised, phase 3, non-inferiority trial. Published June 21, 2018 in The Lancet. First author Dipen J.Parekh, MD, University of Miami, Miami, Fla.
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