In 2 Cancers, Robotic Versus Open Surgery is Explored

Mireya Diaz, PhD

In recent studies, robotic-assisted surgery was explored as a treatment for both prostate and kidney cancers.

In prostate cancer, the newer technique was found to provide 10- year cancer control for men with localized disease. The study did not include a comparator arm in which men received conventional open surgery, but its authors wrote that the two methods produce about equal results at the 10-year mark.

In bladder cancer, investigators compared robotic with open radical cystectomy and determined that the newer approach, while similarly safe, did not reduce complications or length of hospital stays.

10-Year RARP Results Evaluated in Prostate Cancer

Robotic-assisted radical prostatectomy (RARP) confers effective 10- year cancer control to men with localized prostate cancer, similar to the open approach, a study¹ has found. Authors Diaz et al, of Henry Ford Hospital, in Detroit, embarked on the study of patients treated at their institution because, to their knowledge, there had been no other 10-year evaluations of the fairly new RARP approach, and few studies had included 10 years of follow-up on any surgical type strictly within the contemporary PSA era.

The study looked at 483 men with localized prostate cancer who underwent RARP as their initial treatment at the high-volume tertiary center during 2001-2003. Endpoints were biochemical recurrence-free survival (BCRFS), metastasis-free survival (MFS), and cancer-specific survival (CSS).

At a median follow-up of 121 months, there were 108 biochemical recurrences. Actuarial BCRFS, MFS and CSS rates at 10 years were 73.1%, 97.5%, and 98.8%, respectively, the authors found. They also reported on factors that could help physicians create personalized and cost-effective post-operative treatment regimens for their patients.

On multivariable analysis, the authors wrote, D’Amico risk groups or pathologic Gleason grade, stage, and margins were the strongest predictors of BCR, depending on whether pre-operative or postoperative variables were considered. The value of detectable PSA, together with detectable PSA plus disease severity, were independent predictors of whether a man would need salvage therapy; detectable PSA plus persistent PSA were predictors of metastasis.

“Recurrence is best predicted by post-operative disease severity,” the authors wrote. “Persistent disease signals risk of progression likely requiring early salvage treatment, lower post-operative risk warrants protracted surveillance beyond five years from surgery, while those with higher risk may require follow-up beyond 10 years.”

Robot Does Not Reduce Complications in Bladder Cancer

Robot-assisted radical cystectomy does not reduce complications or time in the hospital when compared against traditional surgery for patients with bladder cancer, a study conducted at Memorial Sloan Kettering Cancer Center² has found.

The robotic technique is as safe as standard open surgery, Bochner et al found, although an article about the study on the institution’s website pointed out that the newer technique is more expensive (http://tinyurl.com/mo7p6g6).

The researchers announced their results in a letter that appeared in the New England Journal of Medicine on July 23.

The study of 118 patients randomized 1:1 to either open or robotic cystectomy between March 2010 and March 2013 was among the first randomized trials to evaluate this question; most others have been retrospective, MSKCC reported on its website.

References

1. Diaz M, Peabody JO, Kapoor V, et al. Oncologic outcomes at 10 years following robotic radical prostatectomy. Published online June 25, 2014. Eur Urol.
2. Bochner BH, Sjoberg DD, Laudone VP. A randomized trial of robot-assisted laparoscopic radical cystectomy. NEJM. 2014;371:389-390.