A study comparing different types of surgery for bladder cancer (iROC)

Cancer type:

Bladder cancer

Status:

Results

Phase:

Phase 3

This study compared open surgery with robotic assisted keyhole surgery Open a glossary item for bladder cancer. It was for people whose bladder cancer hadn’t spread.

The study was open for people to join between 2017 and 2020. The team published the results in 2022.

More about this trial

Surgery to remove the bladder is one of the main treatments for bladder cancer. It usually involves having all the bladder removed. This is called a radical cystectomy. Open surgery is when surgeons remove the bladder through a large cut in the tummy (abdomen).

At the time of this study, robotic radical cystectomy was a newer way of doing this surgery. The robotic machine gives the surgeon a better view of the inside of the tummy and allows surgeons to make finer movements. The surgeon sits at a control unit a few feet away from the patient. They control the movement of a set of robotic surgical instruments, guided by a video camera. This type of surgery is usually only done in larger hospitals.

iROC diagram

Researchers weren’t sure which type of surgery worked best. So they did this study to find out more. It was a randomised study:

half the people had open surgery
half the people had keyhole surgery using the robotic surgery technique

The main aims of this phase 3 study Open a glossary item were to compare the 2 surgical techniques to find out:

more about complications during and after surgery
about the length of time people stay in hospital
how each surgery affects quality of life

Summary of results

A total of 338 people joined the study:

169 were in the open surgery group
169 were in the robotic keyhole surgery group

The team had the results for 305 people. They looked at the number of days people were living and were not in hospital. They looked at this within 90 days of having surgery. The research team worked out the median number of days out of hospital by putting the number of days for each person in numerical order. The median is the number in the middle number in that list. They found the number of days out of hospital was:

82 for those who had open surgery
80 for those who had robotic surgery to remove the bladder

During those 90 days, the number of days spent in hospital was about:

8 days for those who had open surgery
7 days for those who had robotic keyhole surgery group

Although these numbers don’t look very different the team say this difference is important.

The team also looked at:

whose cancer had come back
how long people lived

There was no difference between the 2 groups in either of these.

The team also looked at the number of people who had to go back into hospital. This was:

48 out of 149 (32.3%) in the open surgery group
34 out of 156 people (21.8%) in robotic keyhole surgery group

Side effects
The team looked at the number of people who had complications after surgery. The most common for both groups included:

digestive system (gut) problems
infections
problems with the urinary system and other organs near to the surgery area, for example the prostate or ovaries

They found that people who had open surgery had more problems with:

blood clots
their wound. This included infections and wound healing.

Quality of life
The team looked at how surgery affected quality of life. They found that those who had open surgery said they had:

a worse quality of life 5 weeks after surgery and
at 5 and 12 weeks they were finding it difficult to get around and look after themselves

This was compared to those who had robotic surgery.

These differences continued up to about 12 weeks after surgery. After that the team found there weren’t many differences in quality of life.

Conclusion
The study team concluded that people who had robotic surgery had less time in hospital. They had 2 days less than the other group. They also recovered faster after surgery, had fewer wound complications and blood clots.

More detailed information
There is more information about this research in the reference below.

Please note, the information we link to here is not in plain English. It has been written for healthcare professionals and researchers.

Effect of Robot-Assisted Radical Cystectomy With Intracorporeal Urinary Diversion vs Open Radical Cystectomy on 90-Day Morbidity and Mortality Among Patients With Bladder Cancer. A Randomized Clinical Trial Title of the article
J Catto and others
Journal of the American Medical Association (JAMA), 2022. Volume 327, number 21. pages 2092 - 2103

Where this information comes from
We have based this summary on the information in the article above. This has been reviewed by independent specialists (peer reviewed Open a glossary item ) and published in a medical journal. We have not analysed the data ourselves. As far as we are aware, the link we list above is active and the article is free and available to view.