.This Month's Clinical Focus:.
.NEPHROLOGY / UROLOGY.
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major study comparing robotic to open surgery published in The Lancet
The 7-year study, conducted at 15 institutions, was published in the
June 23 issue of The Lancet.
The first comprehensive study comparing the outcomes of robotic surgery to those of traditional open surgery in any
organ has found that the surgeries are equally effective in treating bladder cancer. The Randomized Open Versus Robotic Cystectomy (RAZOR) trial showed lower blood loss and blood transfusion rates and shorter hospital stays for patients who received minimally
invasive surgery, but there were no differences in complication rates and the two-year progression-free survival was nearly the same.
"We have done more than 4 million surgeries with the robotic approach since the device came into existence, and on average we do close to a million robotic surgeries a year globally,"
said Parekh, who is chief clinical officer of the University of Miami Health System. "There are close to 5,000 robotic systems installed all over the world – each one costs about $2 million – and yet until we did this study there was not a single Phase 3 multicenter
randomized trial comparing this expensive new technology to the traditional open approach of doing surgeries."
A total of 350 patients were involved in the bladder cancer study. Half received the open surgical approach and half received robotic surgery, and they were followed for two to
three years so that outcomes could be compared.
"No one had followed these patients over a period of time to find out if you are impacting their cancer outcomes with
this robotic approach," Parekh said. "We were able to prove unequivocally that we are not compromising patient outcomes by using robotic surgery." There has been an assumption that patients who receive robotic surgery will perceive a better quality of life
than patients who have open surgery. Patients participating in the RAZOR study were asked about their quality of life at three and six months after surgery, and while both groups reported a significant return to their previous quality of life, there was no
advantage of one group over the other.
Some critics of robotic surgery have expressed concern about the lack of tactile feedback – an important guide in open
surgery. "When you do robotic surgery you don't feel anything," Parekh said. "It's more by visual cues. If you're doing open surgery you have the organs in your hands, you can feel them, and you assess and do these surgeries accordingly." And while there
are improvements in perioperative recovery with robotic technology, operating room time is significantly longer for robotic surgery. It provides a magnified, three-dimensional view of the organs, and a wide range of motion and flexibility. Robotic surgery
has become particularly popular with prostate cancer patients – 90 percent of them choose it – which would make it difficult if not impossible to do a randomized study of surgical results in prostate cancer. But Parekh says that because robotic surgery is
being used in many other organs, including kidney, colorectal, OB/GYN and lung cancer, more studies are needed.
"The findings of this study provide high-level evidence to inform a discussion between patients and their physicians
regarding the benefits and risks of various approaches for a complex and often morbid surgery, like radical cystectomy," the trial description says. "It also underscores the need for further high-quality trials to critically evaluate surgical innovation.
SOURCE: Article usage courtesy of PRNewswire
with early kidney cancer see significant benefits with robotic partial nephrectomy
A new study from the USC Keck School of Medicine finds that robotic partial nephrectomy decreases complications, mortality as
compared with open or laparoscopic techniques.
For patients with early kidney cancer, removing part of the kidney instead of the whole kidney is often a preferred
treatment because the procedure can effectively remove tumors while preserving kidney function. But when it comes to the best surgical approach — robotic, laparoscopic or open — for this type of surgery, known as partial nephrectomy, the choice has been less
clear. A comprehensive study by the Keck School of Medicine of USC, which has found that robotic partial nephrectomy offers significantly better patient outcomes, may help inform those decisions.
partial nephrectomy has become increasingly more common, yet there's a lack of consensus among urologists about its performance vis-a-vis open or laparoscopic techniques," says the study's corresponding author Inderbir Gill, MD, chair and distinguished professor
of urology at the Keck School. "Our goal with this study was to critically evaluate the impact of these three techniques on patient outcomes such as complications, cancer recurrence and mortality."
The systematic review and meta-analysis, published in the
The Journal of Urology,
combined data from 98 studies on robotic, open and laparoscopic partial nephrectomy. More than 20,000 patients were included in the analysis.
When comparing robotic to open partial nephrectomy, the study found that robotic partial nephrectomy offered several
superior patient outcomes, including decreased complications during and after surgery, cancer recurrence, overall mortality, hospital length of stay and readmission. There was no difference in cancer-specific mortality between the two techniques. Results
also showed that robotic partial nephrectomy was equivalent to, and sometimes better than, laparoscopic partial nephrectomy. While there was no difference in cancer recurrence, cancer-specific mortality, length of hospital stay or readmission, a robotic technique
was associated with lower overall mortality and fewer complications during and after surgery.
Gill, who is the executive director of the USC Institute of Urology at Keck Medicine of USC, believes the data suggest
that the technique of robotic partial nephrectomy has now become established in the field. "Our study shows that robotic partial nephrectomy is not only safe and effective but also a preferred approach for treating small kidney tumors," he says.
Article usage courtesy of PRNewswire
Image credits: Robotic Davinci Surgical By Cornell Urology CC BY-SA 3.0; Kidney by ibrandify via FREEPIK Free Lic CC0