Laparoscopic, robotic-assisted, and open radical cystectomy are associated with similar long-term oncologic outcomes among patients with muscle-invasive or high-risk nonmuscle-invasive bladder cancer, according to findings from the CORAL study, the only randomized trial comparing the 3 surgical approaches.

In the study, investigators randomly assigned patients with muscle-invasive bladder cancer (MIBC, 38 patients) or high-risk non-muscle invasive bladder cancer (HRNMIBC, 21 patients) to undergo laparoscopic radical cystectomy (LRC, 19 patients), robotic-assisted radical cystectomy (RARC, 20 patients), or open radical cystectomy (ORC, 20 patients).

The 5-year recurrence-free survival (RFS) rates associated with these procedures were 71%, 58%, and 60%, respectively, Muhammad Shamim Khan, MBBS, of  Guy’s & St Thomas’ NHS Foundation Trust in London and MRC Centre for Transplantation, King’s College London, and colleagues reported in European Urology. The 5-year cancer-specific survival (CSS) rates were 69%, 68%, and 64%, respectively. The 5-year overall survival (OS) rates were 61%, 65%, and 55%, respectively.

The median follow-up for patients in the LRC, RARC, and ORC arms was 83.8, 86.6, and 65.6 months, respectively. The median follow-up for survivors was 91.4, 102.7, and 104.7 months, respectively.

Dr Khan and his team concluded that the 3 surgical approaches demonstrated no significant differences in 5-year RFS, CSS, and OS. “Minimally invasive techniques achieved similar oncological outcomes to the gold standard of ORC,” they wrote. “However, the results need to be interpreted with caution due to the small sample size.”

Findings should provide some reassurance to clinicians and patients, according to the investigators.

Patients in the LRC, RARC, and ORC groups had preoperative median ages of 71, 68, and 68 years, respectively. Males made up the majority of patients in all 3 treatment arms (79%, 85%, and 90%, respectively).

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The authors noted that minimally invasive techniques provide benefits such as decreased blood loss, more rapid recovery, shorter hospital stay, and a reduction in wound complications. “However, aside from these perioperative benefits, there is as yet little evidence to suggest that these approaches yield superior oncological outcomes, which are largely dependent on the local stage and biology of the disease, and perhaps the experience of the surgeons performing the procedures.”

Reference

Khan MS, Omar K, Ahmed K, et al. Long-term oncological outcomes from an early phase randomized  controlled three-arm trial of open, robotic, and laparoscopic radical cystectomy (CORAL). Eur Urol. 2019.

https://doi.org/10.1016/j.eururo.2019.10.027