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Radical Cystectomy for Bladder Cancer: Comparison of Surgical Techniques From Sweden

By: Joseph Fanelli
Posted: Monday, June 27, 2022

According to findings presented in JAMA Network Open, robot-assisted laparoscopic radical cystectomy may result in fewer mortalities, fewer high-grade complications, and more favorable perioperative outcomes for patients with bladder cancer compared with open radical cystectomy. The minimally invasive technique, concluded Ashkan Mortezavi, MD, of the Karolinska Institutet, Stockholm, and colleagues, was associated with less estimated blood loss, a lower intraoperative transfusion rate, a higher lymph node yield, and a shorter hospital length of stay.

“These findings suggest that in spite of the technically complex nature of the fully intracorporeal approach, nationwide implementation is feasible, with beneficial outcomes for patients with bladder cancer,” the authors said.

In this population-based cohort study, the authors included 3,169 patients who underwent cystectomy for bladder cancer in Sweden from 2011 to 2018. Throughout the observation period, 889 patients had robot-assisted laparoscopic radical cystectomy, and 2,280 had open radical cystectomy across 24 Swedish hospitals. The median patient age was 71 years, and 75.3% of the patients were men.

After a median follow-up of 47 months, the 5-year cancer-specific mortality was 30.2% with open radical cystectomy and 27.6% with robot-assisted laparoscopic radical cystectomy, for overall survival rates of 57.7% and 61.4%, respectively. A propensity score–matched analysis revealed that robot-assisted laparoscopic radical cystectomy was associated with lower all-cause mortality, and it also was associated with less estimated blood loss (median 150 mL) compared with open radical cystectomy (median 700 mL). Patients treated with robot-assisted laparoscopic radical cystectomy also had a lower risk of grade ≥ 3 Clavien-Dindo classification complications compared with those who had open radical cystectomy.

Disclosure: For a full disclosure of the study authors, visit jamanetwork.com.


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