A
recent clinical trial revealed faster recovery times for patients when
bladder cancer removal and reconstruction was done with robot-assisted
surgery
When
robot-assisted surgery is used for bladder cancer removal and
reconstruction, patients recover far more quickly and spend
significantly less time in hospital.
In a first-of-its kind clinical trial, published in JAMA, scientists have suggested that their new findings provide the ‘strongest evidence so far’ of the patient benefit of robot-assisted surgery.
Co-chief
investigator, Professor John Kelly, Consultant Surgeon at University
College London (UCL) Hospitals and Professor of Uro-oncology at UCL’s
division of Surgery and Interventional Science, explained that, despite
robot-assisted surgery becoming more widely available, there had been ‘no significant clinical evaluation of its overall benefit to patients’ recovery’.
For
the new study, led by scientists at UCL and the University of
Sheffield, researchers set out to compare recovery and morbidity after
robot-assisted radical cystectomy with intracorporeal reconstruction
versus open radical cystectomy. In the trial, which involved 29 surgeons
at nine
UK hospital trusts, 338 patients with non-metastatic bladder
cancer—recruited from March 2017 to March 2020—were randomised to
receive robot-assisted surgery (169) or open surgery (169). Follow-up
was conducted at 90 days, 6 months, and 12 months, with final follow-up
on 23 September 2021.
The
primary outcome was the number of days alive and out of the hospital
within 90 days of surgery. In addition, there were 20 secondary
outcomes, including complications, quality of life, disability, stamina,
activity levels, and survival.
Unexpected and striking finding
On
average, the robot-assisted group stayed 8 days in hospital, compared
with 10 days for the open surgery group—a 20% reduction. Re-admission to
hospital within 90 days of surgery was also significantly reduced, 21%
for the robot-assisted group versus 32% for open surgery.
All
secondary outcomes were improved by robot-assisted surgery or, if not
improved, almost equal to open surgery, the authors said.
The
researchers also found that patients undergoing robot-assisted surgery
were less likely to experience thromboembolic complications compared
with patients who had open surgery (1.9% versus 8.3%), and also less
likely to experience wound-related complications (5.6% versus 16.0%).
Professor Kelly highlighted that the ‘unexpected’ and ‘striking’ finding of a reduction in thromboembolic complications indicated a ‘safe surgery with patients benefiting from far fewer complications, early mobilisation, and a quicker return to normal life’.
Patients’
physical activity (assessed by daily steps tracked on a wearable smart
sensor), stamina, and quality of life also increased.
Hope for robotic surgery to be offered more widely
About
10,000 people are diagnosed with bladder cancer in the UK every year
and over 3000 bladder removals and reconstructions are performed. It is
one of the most expensive cancers to manage, said the authors.
Co-Chief
Investigator Professor James Catto, Professor of Urological Surgery at
the Department of Oncology and Metabolism, University of Sheffield,
said: ‘Time in hospital is reduced and recovery is faster when using this advanced surgery.
‘Ultimately,
this will reduce bed pressures on the NHS and allow patients to return
home more quickly. We see fewer complications from the improved mobility
and less time spent in bed.’
Open
surgery remains NICE’s ‘gold standard’ recommendation for highly
complex surgeries, though the research team hope this could change.
Professor Kelly added: ‘In
light of the positive findings, the perception of open surgery as the
gold standard for major surgeries is now being challenged for the first
time.’
The
researchers said that the findings provide the strongest evidence so
far of the patient benefit of robot-assisted surgery. They are now
urging NICE to make it available as a clinical option across the UK for
all major abdominal surgeries including colorectal, gastrointestinal,
and gynaecological.
Professor Catto highlighted that the study also points to future trends in healthcare. He explained: ‘Soon,
we may be able to monitor recovery after discharge, to find those
developing problems. It is possible that tracking walking levels would
highlight those who need a district nurse visit or perhaps a checkup
sooner in the hospital.’
Professor Kelly concluded: ‘In
this study we wanted to establish if robot-assisted surgery, when
compared with open surgery, reduced time spent in hospital, reduced
re-admissions, and led to better levels of fitness and a quality of
life—on all counts this was shown.’
He
expressed his hope that in the future all eligible patients needing
major abdominal operations would be offered the option of having robotic
surgery.
This article was originally publised on Medscape, part of the Medscape Professional Network.
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