Elsevier

Urology

Volume 83, Issue 6, June 2014, Pages 1300-1308
Urology

Laparoscopy and Robotics
Health-related Quality of Life Outcomes After Robot-assisted and Open Radical Cystectomy Using a Validated Bladder-specific Instrument: A Multi-institutional Study

https://doi.org/10.1016/j.urology.2014.02.024Get rights and content

Objective

To evaluate health-related quality of life (HRQL) using validated bladder-specific Bladder Cancer Index (BCI) and European Organization for Research and Treatment of Cancer Body Image scale (BIS) between open radical cystectomy (ORC) and robot-assisted radical cystectomy (RARC).

Methods

This was a retrospective case series of all patients who underwent radical cystectomy. Patients were grouped based on surgical approach (open vs robot assisted) and diversion technique (extracorporeal vs intracorporeal). Patients completed BCI and BIS preoperatively and at standardized postoperative intervals (at least 2). The primary exposure variable was surgical approach. The primary outcome measure was difference in interval and baseline BCI and BIS scores in each group. The Fisher exact, Wilcoxon rank-sum, and Kruskal-Wallis tests were used for comparisons.

Results

Eighty-two and 100 patients underwent RARC and ORC, respectively. Compared with RARC, more patients undergoing ORC had an American Society of Anesthesiology score ≥3 (66% vs 45.1% RARC; P = .007) and shorter median operative time (350 vs 380 minutes; P = .009). Baseline urinary, bowel, sexual function, and body image were not different between both the groups (P = 1.0). Longitudinal postoperative analysis revealed better sexual function in ORC group (P = .047), with no significant differences between both the groups in the other 3 domains (P = .11, .58, and .93). Comparisons regarding diversion techniques showed similar findings in baseline and postoperative HRQL data, with no significant differences in the HRQL and body image domains.

Conclusion

RARC has comparable HRQL outcomes to ORC using validated BCI and BIS. The diversion technique used does not seem to affect patients' quality of life.

Section snippets

Patient Population

As part of institutional review board–approved quality assurance databases, all patients undergoing radical cystectomy with ileal conduit urinary diversion at Roswell Park Cancer Institute and University of Michigan between January 2009 and December 2012 were included in this retrospective case series. All patients completed the BCI and BIS preoperatively and at standardized postoperative intervals (at least twice postoperatively). Follow-up questionnaires were completed at the first

Results

One hundred eighty-two patients who underwent either RARC or ORC met the inclusion criteria and were included in this retrospective case series. One hundred patients had ORC and 82 patients had RARC; meanwhile, RARC patients were further subdivided according to the diversion (40 extracorporeal and 42 intracorporeal).

Discussion

Comparative effectiveness of RARC and the gold standard ORC is needed, not only regarding perioperative and oncologic outcomes but also from a quality of life perspective as well. This study is the first of its kind, to our knowledge, to use validated HRQL assessment measures (BCI and BIS) to evaluate and compare HRQL between RARC and ORC. We also compared the HRQL outcomes based on the diversion technique used (extracorporeal vs intracorporeal).

Our analysis showed no advantage of any approach

Conclusion

HRQL outcomes between ORC and RARC, with ileal conduit diversion, are not different based on BCI and BIS instruments. Better sexual functions are noted in the open group over time only. No quality of life differences were noted based on the diversion technique used.

References (26)

Cited by (37)

  • Influence of Simple and Radical Cystectomy on Sexual Function and Pelvic Organ Prolapse in Female Patients: A Scoping Review of the Literature

    2019, Sexual Medicine Reviews
    Citation Excerpt :

    Comparison of surgical approach has been shown to influence outcomes as well.9,51–56 A retrospective case series comparing quality-of-life outcomes between open and robot-assisted radical cystectomy using the Bladder Cancer Index and Body Image Scale found that the open approach had better sexual function outcomes than the robotic group.57 However, a study conducted 2 years later found no difference in sexual function.

  • Robotic Surgery of the Kidney, Bladder, and Prostate

    2016, Surgical Clinics of North America
View all citing articles on Scopus

Financial Disclosure: Khurshid A. Guru is a board member of Simulated Surgical Systems LLC. The remaining authors declare that they have no relevant financial interests.

View full text