Robotic surgery effective but costly in bladder cancer

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Robotic-assisted laparoscopic radical cystectomy (RARC) is associated with lower parenteral nutrition use and fewer inpatient complications and deaths compared with the more invasive approach of open radical cystectomy (ORC), but lengths of stay are similar for both operations and RARC is significantly more costly.

These were the findings of a retrospective observational cohort study using the US Nationwide Inpatient Sample to compare inpatient morbidity and mortality, lengths of stay, and costs for RARC and ORC. A group led by Jim C. Hu, MD, MPH, director of minimally invasive urology at the David Geffen School of Medicine at University of California, Los Angeles, identified 1,444 ORC cases and 224 RARC cases, with women being less likely to undergo RARC than ORC (9.8% vs 15.5%).

The investigators learned the following:

  • Persons undergoing RARC experienced fewer inpatient complications than those undergoing ORC (49.1% compared with 63.8%). However, there were no differences in lengths of stay between the two groups.
  • Parenteral nutrition use was lower in the RARC group than in the ORC group (6.4% vs 13.3%).
  • Deaths were less likely to occur in the RARC group than in the ORC group (0% vs 2.5%).
  • RARC cost $3,797 more than ORC.

“While we expected to see greater expenses associated with the robotic procedure for bladder cancer, we were surprised to see the significant reduction in deaths and complications,” noted Hu in a statement describing his team's findings, which were published by European Urology.

As Hu's team noted in their report, their research was limited by its retrospective design, an absence of data on tumor characteristics, and a lack of outcomes data beyond hospital discharge.

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