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Results of Roswell Park study boost robot-assisted surgery for bladder cancer patients

Patients with bladder cancer who underwent robot-assisted surgery experienced similar results to those who had traditional operations, according to a new international study led by Roswell Park Cancer Institute.

The retrospective review of long-term outcomes for 702 patients at 11 institutions in six countries is the largest multi-institutional study to examine the differences between the two surgical techniques, the researchers said.

The results were published in the journal of the European Association of Urology.

“We found that robot-assisted radical cystectomy, an advanced surgical procedure used to treat bladder cancer that has spread to the bladder wall or recurred, despite local treatment in the bladder, provides similar early oncological outcomes while reducing operative blood loss,” said Dr. Khurshid Guru, director of robotic surgery at Roswell Park and senior author of the paper.

A cystectomy is removal of all or part of the urinary bladder.

Advocates tout the robot over traditional surgery or laparoscopy, a minimally invasive procedure. They say the benefits of robot-assisted surgery include fewer complications, less blood loss and shorter operating times than traditional open surgery.

Skeptics say the robot is costly – more than $2 million – and previous studies have offered mixed results as to whether the device leads to better outcomes. The rush by doctors and hospitals to use robots, they contend, is far ahead of the evidence showing that the devices perform as well as or better than traditional surgeries.

The latest study reviewed outcomes for cystectomies in cancer patients tracked by the International Robotic Cystectomy Consortium. Data from 2003 to date were analyzed for five-year recurrence-free survival, bladder cancer survival and overall survival. When compared with traditional surgery, patients treated with robot-assisted surgery experienced similar outcomes, the researchers concluded.

“The landmark in cancer is five-year survival. Our results show robot-assisted surgery produces similar results. That’s the first big step in accepting robotics as part of the medical armamentarium for bladder cancer,” Guru said.

A retrospective look at patient data is not considered as rigorous a test as a randomized controlled trial comparing one treatment against another. But randomized trials are rarely done for procedures.

“Simply developing and using new minimally invasive surgery (MIS) techniques during surgery isn’t enough. The medical community demands proof that MIS provides standard oncologic results as effective as open surgical standards,” says Dr. James Mohler, associate director and senior vice president for Translational Research at Roswell Park. “This research is useful in continuing to document the viability of the new surgical therapies for the treatment of cancer.”

Guru said he’s optimistic future research will show robot-assisted surgery offers an improvement over traditional surgery.

“You are comparing a 100-year-old technique with a 10-year-old one,” he said. “We will get better with time.”

The study was supported in part by the Vattikuti Foundation, which supports robotic surgery projects.