Robot-assisted Radical Cystectomy on the Rise
By 2014 to 2015, 1 in 3 bladder cancer surgical procedures performed in the United States were robot-assisted.
|The following article is part of conference coverage from the 2017 American Urological Association meeting in Boston. Renal and Urology News' staff will be reporting live on medical studies conducted by urologists and other specialists who are tops in their field in kidney stones, prostate cancer, kidney cancer, bladder cancer, enlarged prostate, and more. Check back for the latest news from AUA 2017.|
BOSTON — Use of robotic-assisted radical cystectomy (RARC) has increased in recent years in the United States, according to study findings presented at the American Urological Association 2017 annual meeting.
Jeffrey J. Leow, MBBS, MPH, MRCS, Benjamin I. Chung, MD, and Steven L. Chang, MD, MS, reported that adoption of the less invasive surgical technique for bladder cancer increased from 2008 to 2015. National estimates were generated based on data from more than 40,000 radical cystectomy (RC) patients from 381 hospitals, including 8360 RARC (20.5%) and 32,377 open RC patients, within the Premier Healthcare Database. By 2015, the end of the study period, RARC was performed in 1 in 3 procedures (34.5%).
Although length of hospital stay was shorter for RARC patients, 90-day complication rates were similar between procedures. These included overall surgical complications and major complications of grade 3 or above on the Clavien Dindo classification scale, which require intervention beyond drug therapy or prove life-threatening.
Higher surgeon case load and more contemporary years of surgery were associated with increased utilization of RARC. Significantly, surgeons who performed 6 or more RC procedures per year were twice as likely to use RARC. Likewise, hospitals that conducted more than 17 radical cystectomies annually utilized RARC 9% more, although this was not statistically significant.
“This may be attributed to surgeons acquiring robotic surgical skills and becoming more familiar with transperitoneal pelvic anatomy following the widespread use of robot-assisted radical prostatectomy,” Dr Leow and the team explained.
A range of other sociodemographic, geographic, and clinical factors were significantly associated with RARC use. Patients who underwent RARC were more likely to be older, male, married, and privately insured. Patients with more comorbidities (2 or higher on the Charlson comorbidity index were less likely to undergo the robotic procedure.
Leow J, Chung B, and Chang S. Trends in surgical approach and outcomes for radical cystectomy: A contemporary population-based analysis. [abstract] J Urol 2017;197(4S):e725. Poster presented at the American Urological Association 2017 annual meeting in Boston on May 14, 2017. Poster MP54-09.