Open Vs Robotic-Assisted Radical Cystectomy: A Randomized Trial
Trial Snapshot
- Phase
- Not Applicable
- Status
- Completed
- Sponsor
- University of Miami
- Enrollment
- 350
- Locations
- 32
- Primary Endpoint
- Percentage of Participants With 2-year Progression Free Survival (PFS)
Study Overview
Brief Summary
This is a multi-institutional, randomized trial evaluating oncologic, perioperative, and functional outcomes following two standard care procedures for radical cystectomy. The participants will have one of the standard care procedures as part of their care. The two procedures that will be followed are open radical cystectomy and robotic assisted radical cystectomy (RARC). Open cystectomy is considered to be the more traditional approach. While newer, RARC is considered to be equivalent to open surgery when it is performed by a trained robotics surgeon. The reported complication rates of RARC appear comparable to open surgery. This means there is no significant difference in the risk between the two standard procedures. However, despite these potential advantages, true comparison between the open and robotic technique with regards to long term cancer related and functional outcomes has not been accomplished because previous studies did not compare patients of equal health status. The researchers hope to learn whether or not patients undergoing RARC recover more quickly than or at the same rate as patients undergoing an open radical cystectomy while having non inferior cancer related outcomes. This study is funded by the National Institutes of Health (NIH).
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Treatment
- Masking
- None
Eligibility Criteria
- Ages
- 18 Years to — (Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •Patient must have biopsy proven bladder cancer. Official pathology report reviewed at the participating institution is required.
- •Bladder cancer must be clinical stage T1-T4, N0-1, M
- •(AJCC 7th edition) or refractory cis (carcinoma in situ).
Exclusion Criteria
- •Inability to give informed consent.
- •Prior major abdominal and pelvic open surgical procedures that would preclude a safe robotic approach, as determined by the treating surgeon.
- •At the discretion of the treating surgeon, any pre-existing condition such as severe chronic obstructive pulmonary disease that precludes a safe initiation or maintenance of pneumoperitoneum over a prolonged period of time and during surgery.
- •Age <18 or >99 years.
Outcomes
Primary Outcomes
Percentage of Participants With 2-year Progression Free Survival (PFS)
Time Frame: 24 months
Progression will be determined by the treating physician using the Response Evaluation Criteria in Solid Tumors (RECIST) Version 1.1 criteria based on radiographic or pathological evidence of disease progression or death from disease.
Number of Participants With Positive Margins
Time Frame: At time of cystectomy, approximately 1 hour.
Evaluated are the number of participants with positive surgical, bladder, and urethral margins. Positive margin is defined as presence of tumor cells at the edge of the dissected tissue.
Number of Participants Requiring Lymph Node Dissection
Time Frame: At time of cystectomy, approximately 1 hour
Evaluated are the number of participants requiring extended or standard lymph node dissection
Quality of Life (QOL) Outcomes
Time Frame: at baseline, 3 month, and 6 months
Functional Assessment of Cancer Therapy- Vanderbilt Cystectomy Index (FACT-VCI) scores range is 0-168 which is sum of physical, emotional, wellbeing, and FACTS Bl Cys. higher scores=better QOL.
Number of Participants With Post-surgical Complications
Time Frame: 90 days post operative
Post surgical complications will be evaluated using the Clavien grading system with scores ranging from 0-5 with the higher number indicating increased post-surgical complications.
Amount of Estimated Blood Loss (EBL) in ml
Time Frame: At time of cystectomy, approximately 1 hour
Perioperative measures such as EBL will be evaluated by measuring the amount of participant blood loss in ml.
Number of Participants Requiring Blood Transfusion
Time Frame: At time of cystectomy, approximately 1 hour
Number of participants requiring peri, intra, and post operative blood transfusion.
Number of Days of Post Operative Length of Hospital Stay
Time Frame: Day 10 post surgery
Number of days of post operative length of hospital stay will be evaluated
Length of Operative Time
Time Frame: At time of cystectomy, approximately 1 hour
Length of minutes of cystectomy procedure
Laboratory Values
Time Frame: baseline, 6 weeks, 3 months, 6 months, 12 months, 24 months, 36 months
Serum Hemoglobin (Hb) and Albumin will be reported in grams per deciliters (g/dL)
Measures of Functional Independence as Assessed by the Activities of Daily Living (ADL) Questionnaire
Time Frame: baseline, 1 month , 3 months, 6 months
Participant reported ADL questionnaire is a 7 item questionnaire with scores ranging from 7-21 with a lower score indicating increased independence.
Percentage of Participants With 3-year Progression Free Survival (PFS)
Time Frame: 3 years
Progression will be determined by the treating physician using the RECIST Version 1.1 criteria based on radiographic or pathological evidence of disease progression or death from disease.
Quality of Life (QOL) Outcomes as Assessed by the Short Form 8 (SF-8) Questionnaire
Time Frame: baseline, 3 month, and 6 month
The SF-8 consists of two component summary scores; physical (PCS) and mental component summary (MCS). They are scored by weighting each score to a norm-based scoring model. The total scores will be reported as a percentile with higher score indicating better quality of health.
Creatinine Value.
Time Frame: baseline, 6 weeks, 3 months, 6 months, 12 months, 24 months, 36 months
Serum creatinine will be reported in milligrams per deciliters (mg/dL).
Performance Related Measures of Functional Independence as Assessed by the Time Up and Go (TUG) Walking Test
Time Frame: baseline, 1 month, 3 months, 6 months
The TUG test is measured in seconds. Patients will be timed as they rise from a standard chair, walk 3 meters, turn, walk back, and sit again.
Total Number of Participants Requiring Intra-operative Fluid Requirement
Time Frame: At time of cystectomy, approximately 1 hour
Total number of participants requiring Intra-operative fluid requirement. (blood+plasma+platelets) Note: In robotic group 1 participant received both plasma and platelets and 1 other received platelets in addition to blood transfusion. In the open group 5 participants received plasma in addition to blood transfusion.
Total Postoperative Analgesic Requirements
Time Frame: At time of cystectomy, approximately 1 hour
Total postoperative analgesic requirements in milli grams
Measures of Functional Independence as Assessed by the Instrumental Activities of Daily Living (IADL) Questionnaire
Time Frame: baseline, 1 month, 3 months, 6 months
Participant reported IADL questionnaire is an 8 item questionnaire with scores ranging from 8-32 with a lower score indicating increased independence.
Performance Related Measures of Functional Independence as Assessed by the Hand Grip Strength Test
Time Frame: baseline, 1 month, 3 months, 6 months
The hand grip strength test is measured in kilograms of pressure using a handheld dynamometer.
Quality of Life (QOL) Outcomes as Assessed by the Functional Assessment of Cancer Therapy - Vanderbilt Cystectomy Index (FACT-VCI) Questionnaire
Time Frame: baseline, 3 months, 6 months
FACT-VCI consists of eight domains: Five subscale scores (physical wellbeing, social wellbeing, emotional wellbeing, functional wellbeing, and FACT for patients with Bladder Cancer following Cystectomy \[FACT-BL-Cys\]) and three derived scores (trial outcome index), FACT-General form (FACT-G), and FACT-BL-Cys Total.The ranges of scores for each domain are as follows: 0-28 for physical, social, and functional wellbeing; 0-24 for emotional wellbeing; 0-60 for FACT-BL-Cys; 0-116 for FACT-VCI Trial Outcome Index (sum of physical wellbeing, functional wellbeing, and FACT-BL-Cys scores); 0-108 for FACT-G (sum of physical, social, emotional, and functional wellbeing scores); and 0-168 for FACT-BL-Cys Total (sum of physical, social, emotional, and functional wellbeing scores, and FACT-BL-Cys).The higher score indicates increased wellbeing.
Secondary Outcomes
- Cost(Day 7)
Investigators
Dipen J Parekh, MD
Chairman of Urology
University of Miami