Our Summary

This study looked at two different methods of surgery for bladder cancer: robot-assisted radical cystectomy with intracorporeal reconstruction and open radical cystectomy. The research was conducted in the UK with patients who had nonmetastatic bladder cancer (meaning the cancer has not spread beyond the bladder).

The main thing the researchers were looking at was how many days patients were alive and out of the hospital within 90 days of their surgery. They also looked at other factors like complications, quality of life, disability, stamina, activity levels, and survival.

The results showed that, on average, patients who had the robot-assisted surgery spent slightly more days alive and out of the hospital compared to those who had the open surgery. The robotic surgery patients also had fewer complications related to blood clots and wound issues. Additionally, these patients reported a better quality of life and less disability in the weeks following surgery.

However, when it came to cancer recurrence and overall mortality, there was no significant difference between the two groups. The researchers concluded that while the robot-assisted surgery did result in some benefits, the clinical importance of these findings is uncertain. In other words, they need to further investigate to determine if these differences significantly impact patient health and recovery in the long term.

FAQs

  1. What is the difference between robot-assisted radical cystectomy with intracorporeal reconstruction and open radical cystectomy?
  2. What were the benefits of the robot-assisted surgery as compared to the open surgery according to the study?
  3. Does the robot-assisted surgery have an impact on cancer recurrence and overall mortality?

Doctor’s Tip

One helpful tip a doctor might tell a patient about urinary diversion surgery is to carefully follow the post-operative care instructions provided by your healthcare team. This may include proper wound care, managing pain and discomfort, monitoring for any signs of infection, and following a specific diet plan to aid in recovery. It’s also important to attend all follow-up appointments to ensure that your healing process is progressing as expected. By taking these steps, you can help optimize your recovery and overall outcome after urinary diversion surgery.

Suitable For

Patients who are typically recommended urinary diversion surgery include those with bladder cancer, neurogenic bladder dysfunction, congenital abnormalities of the bladder, and other conditions that affect the function of the urinary system. In the case of bladder cancer, patients may undergo urinary diversion surgery after a radical cystectomy, which involves removing the bladder. This surgery may be recommended if the cancer has spread beyond the bladder or if the bladder cannot be preserved due to the extent of the disease. Other conditions that may require urinary diversion surgery include spinal cord injuries, multiple sclerosis, and other neurological conditions that affect bladder function.

Timeline

Before urinary diversion surgery:

  1. Diagnosis of nonmetastatic bladder cancer
  2. Consultation with a urologist to discuss treatment options
  3. Preoperative testing and preparation for surgery
  4. Discussion with the surgeon about the specific type of urinary diversion surgery needed
  5. Admission to the hospital for the surgery

After urinary diversion surgery:

  1. Recovery in the hospital for a few days to a week
  2. Monitoring for any complications or infections
  3. Education on how to care for the urostomy or continent diversion
  4. Follow-up appointments with the surgeon to monitor healing and adjust the care plan
  5. Rehabilitation and adjustment to life with a urostomy or continent diversion
  6. Long-term follow-up to monitor for any recurrence of cancer or complications related to the surgery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about urinary diversion surgery, particularly in the context of this study, may include:

  1. What are the potential benefits of robot-assisted radical cystectomy with intracorporeal reconstruction compared to open radical cystectomy for my specific case of bladder cancer?
  2. What are the potential risks and complications associated with each type of surgery?
  3. How long can I expect to be in the hospital and how long is the recovery process for each type of surgery?
  4. Will there be any impact on my quality of life, disability, stamina, or activity levels following the surgery?
  5. What is the likelihood of cancer recurrence and overall mortality with each type of surgery?
  6. Are there any long-term implications or differences in outcomes between robot-assisted surgery and open surgery that I should be aware of?
  7. Have there been any advancements or changes in surgical techniques since the publication of this study that may impact my treatment options?
  8. Are there any alternative treatments or procedures that I should consider before making a decision about urinary diversion surgery?
  9. How experienced is the surgical team in performing robot-assisted radical cystectomy with intracorporeal reconstruction, and what is their success rate with this procedure?
  10. Are there any specific lifestyle changes or precautions I should take before or after the surgery to optimize my recovery and long-term health outcomes?

Reference

Authors: Catto JWF, Khetrapal P, Ricciardi F, Ambler G, Williams NR, Al-Hammouri T, Khan MS, Thurairaja R, Nair R, Feber A, Dixon S, Nathan S, Briggs T, Sridhar A, Ahmad I, Bhatt J, Charlesworth P, Blick C, Cumberbatch MG, Hussain SA, Kotwal S, Koupparis A, McGrath J, Noon AP, Rowe E, Vasdev N, Hanchanale V, Hagan D, Brew-Graves C, Kelly JD; iROC Study Team. Journal: JAMA. 2022 Jun 7;327(21):2092-2103. doi: 10.1001/jama.2022.7393. PMID: 35569079