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JU INSIGHT Health-related Quality of Life After Robotic-assisted vs Open Radical Cystectomy
By: Matthew B. Clements, MD, Lahey Hospital & Medical Center, Burlington, Massachusetts; Benjamin B. Beech, MD, Memorial Sloan Kettering Cancer Center, New York, New York; Thomas M. Atkinson, PhD, Memorial Sloan Kettering Cancer Center, New York, New York; Guido M. Dalbagni, MD, Memorial Sloan Kettering Cancer Center, New York, New York; Yunlin Li, PhD, Memorial Sloan Kettering Cancer Center, New York, New York; Andrew J. Vickers, PhD, Memorial Sloan Kettering Cancer Center, New York, New York; Harry W. Herr, MD, Memorial Sloan Kettering Cancer Center, New York, New York; S. Machele Donat, MD, Memorial Sloan Kettering Cancer Center, New York, New York; Daniel D. Sjoberg, PhD, Memorial Sloan Kettering Cancer Center, New York, New York; Amy L. Tin, BA, MA, Memorial Sloan Kettering Cancer Center, New York, New York; Jonathan A. Coleman, MD, Memorial Sloan Kettering Cancer Center, New York, New York; Bruce D. Rapkin, PhD, Albert Einstein College of Medicine, Bronx, New York; Vincent P. Laudone, MD, Memorial Sloan Kettering Cancer Center, New York, New York; Bernard H. Bochner, MD, Memorial Sloan Kettering Cancer Center, New York, New York | Posted on: 18 May 2023
Clements MB, Beech BB, Atkinson TM, et al. Health-related quality of life after robotic-assisted vs open radical cystectomy: analysis of a randomized trial. J Urol. 2023;209(5):901-910.
Study Need and Importance
Prior randomized trials have evaluated health-related quality of life (QoL) after robotic vs open radical cystectomy, but have included short follow-up periods (generally 6 months or less) and measures evaluating a limited number of QoL domains. While the recent iROC trial evaluated short-term outcomes and measures of disability, no studies have evaluated longer-term outcomes and included broader urinary, bowel, sexual, and psychosocial QoL assessment.
What We Found
In a secondary analysis of patients who enrolled in a single-institution, randomized trial of open vs robotic cystectomy, we analyzed 14 patient-reported outcomes measures at 3, 6, 12, 18, and 24 months postoperative. Mean differences in general cancer-related related QoL were small. For instance, Global QoL differed by 1.1/100 (95% CI −8.4, 6.2) and Physical Functioning by 0.4/100 (95% CI −5.8, 5.0). Similar small differences were seen in bladder cancer−specific QoL, with difference in Body Image of 2.9/100 (95% CI −7.2, 13.1) and 8.0/100 (95% CI −3.0, 19.0) for Urinary Symptoms between open and robotic cystectomy. Other domains evaluating urinary, bowel, sexual, and psychosocial health-related QoL were similar. For Urostomy Symptoms, there was some evidence of lower scores at the 3-and 24-month time points for open surgery. However, for the other domains studied, there was no evidence of different effects at earlier or later time points after cystectomy.
Limitations
This study included only a subset of patients from the original randomized trial (61%); however, baseline clinical characteristics and QoL were similar between groups.
Interpretation for Patient Care
Over a broad range of QoL domains comparing robotic and open radical cystectomy, there are unlikely to be clinically relevant differences in the medium to long term, and QoL over this time period should not be a consideration in choosing between approaches.
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