Robotic or Human Hands for Cancer Surgery?

Bladder cancer cystectomy operative techniques compared

(RxWiki News) From a surgeon’s point of view, robotic surgery is sort of like a video game. The surgeon sits at a console and controls the robot’s arms and hands. As with all types of surgery, a great deal of training is required. A new review compared robotic and open surgery for treating bladder cancer.

An analysis of comparative studies concluded that robotic surgery was superior to traditional surgery for removing the bladder to treat bladder cancer.

The review found the robotic surgery shortened hospital stays, and resulted in fewer complications, less blood loss and fewer transfusions during surgery.

Alexander Kutikov, MD, a dailyRx News Contributing Expert and specialist in bladder cancer at Fox Chase Cancer Center, noted that another recent study disputes these findings.

"Talk to your surgeon about the type of operation you’ll undergo."

This review was conducted by a group of Chinese researchers led by Kaiwen Li of Sun Yat-sen University in Guangzhou, China.

For advanced bladder cancer, an operation called a radical cystectomy is used to remove the diseased organ.

For this review, the investigators analyzed published studies that compared robotic-assisted radical cystectomy (RARC) with open (traditional) radical cystectomy (ORC).

In the background section of the study, the authors pointed out that RARC is becoming an increasingly popular method for treating bladder cancer.

To compare the effectiveness of the surgical techniques, the researchers looked at operation times, complications during surgery, how many lymph nodes were retrieved (lymph node yield), blood loss, need for blood transfusions during the operation and length of hospital stay. Removing lymph nodes is done to limit the possibility the cancer will spread.

The review found that overall complications — both minor and major — were about 32 percent lower in the RARC group compared to the ORC group.

Mortality (death) rates were slightly higher in robotic assisted surgery (1.6 percent) compared to open surgery (0.9 percent).

Hospital stays were longer in the ORC group, blood loss was greater and patients in this group required more blood transfusions during surgery, the researchers found.

Dr. Kutikov, associate professor of urologic surgical oncology at Fox Chase Cancer Center in Philadelphia, PA, reviewed this meta-analysis.

“This particular meta-analysis examined groups of patients who were specifically pre-selected for either robotic or open approach (i.e., the patients were not randomized). As such, patients who underwent open surgery likely differed from those patients who chose or were selected for the robotic approach,” Dr. Kutikov explained.

If the participants had been randomized, the results would have been more meaningful, according to Dr. Kutikov.

He went on to say that a randomized trial recently reported at the American Urological Association meeting “...failed to show differences in complication rates, length of hospital stay, or lymph node yield when cystectomy was performed by an expert open or a robotic surgeon. Operative times were shorter with open surgery, but patients who underwent robotics enjoyed less blood loss.”

So what does all this mean for patients?

"As we have now learned from experience with other types of surgeries that can be performed robotically, the adage ‘it's not the car, it's the driver’ appears to apply to robotic cystectomy as well,” Dr. Kutikov pointed out.

"In fact, expert bladder surgeons can now offer both traditional open and robotic techniques for patients requiring cystectomy, and those who are faced with advanced bladder cancer should seek these individuals to discuss the nuances and trade-offs that are involved with this decision,” Dr. Kutikov said.

This study was published in the October issue of Cancer Treatment Reviews.

The National Natural Science Foundation of China), Guangdong province Natural Scientific Foundation the Yat-sen Scholarship for Young Scientists the Clinical Key Project of Public Health Ministry and the Program for New Century Excellent Talents in University funded this research. No conflicts of interest were reported.

Reviewed by: 
Review Date: 
September 19, 2013