Health-related Quality of Life After Robotic-assisted vs Open Radical Cystectomy: Analysis of a Randomized Trial

Abstract

Purpose: We compare health-related quality of life using a broad range of validated measures in patients randomized to robotic-assisted radical cystectomy vs open radical cystectomy.

Methods: We retrospectively analyzed patients that had enrolled in both a randomized controlled trial comparing robotic-assisted laparoscopic radical cystectomy vs open radical cystectomy and a separate prospective study of health-related quality of life. The prospective health-related quality of life study collected 14 patient-reported outcomes measures preoperatively and at 3, 6, 12, 18, and 24 months postoperatively. Linear mixed-effects models with an interaction term (study arm×time) were used to test for differences in mean domain scores and differing effects of approach over time, adjusting for baseline scores.

Results: A total of 72 patients were analyzed (n=32 robotic-assisted radical cystectomy, n=40 open radical cystectomy). From 3-24 months post-radical cystectomy, no significant differences in mean scores were detected. Mean differences were small in the following European Organization for Research and Treatment of Cancer QLQ-C30 (Core Quality of Life Questionnaire) domains: Global Quality of Life (-1.1; 95% CI -8.4, 6.2), Physical Functioning (-0.4; 95% CI -5.8, 5.0), Role Functioning (0.7; 95% CI -8.6, 10.0). Mean differences were also small in bladder cancer-specific domains (European Organization for Research and Treatment of Cancer QLQ-BLM30 [Muscle Invasive Bladder Cancer Quality of Life Questionnaire]): Body Image (2.9; 95% CI -7.2, 13.1), Urinary Symptoms (8.0; 95% CI -3.0, 19.0). In Urostomy Symptoms, there was a significant interaction term (P < .001) due to lower open radical cystectomy scores at 3 and 24 months. Other domains evaluating urinary, bowel, sexual, and psychosocial health-related quality of life were similar.

Conclusions: Over a broad range of health-related quality of life domains comparing robotic-assisted radical cystectomy and open radical cystectomy, there are unlikely to be clinically relevant differences in the medium to long term, and therefore health-related quality of life over this time period should not be a consideration in choosing between approaches.

Keywords: carcinoma; cystectomy; quality of life; robotic surgical procedures; transitional cell; urinary bladder neoplasms.

Figure 1.

Randomization of study patients. The dashed line indicates analysis off of the initial trial protocol. ORC indicates open radical cystectomy; QOL, quality of life; RARC, robotic-assisted radical cystectomy; RC, radical cystectomy.

Figure 2.

Linear mixed-effects model estimates of mean scores over 24 months of follow-up for selected domains comparing open radical cystectomy (blue) and robotic-assisted radical cystectomy (orange). Models are adjusted for baseline domain scores. EORTC indicates European Organization for Research and Treatment of Cancer; QLQ-BLM30, Muscle Invasive Bladder Cancer Quality of Life Questionnaire; QLQ-C30, Core Quality of Life Questionnaire; QOL, quality of life; RC, radical cystectomy.

Figure 3.

Linear mixed-effects model estimates of mean scores over 24 months of follow-up for selected domains comparing open radical cystectomy (blue) and robotic-assisted radical cystectomy (orange). Models are adjusted for baseline domain scores. DCS indicates Decisional Conflict Scale; EORTC, European Organization for Research and Treatment of Cancer; FRQ, Fear of Recurrence Questionnaire; IIQ, Incontinence Impact Questionnaire; MHI, Mental Health Inventory; MSK BFI, Memorial Sloan Kettering Cancer Center Bowel Function Index; QLQ-BLM30, Muscle Invasive Bladder Cancer Quality of Life Questionnaire; RC, radical cystectomy; SWLS, Satisfaction With Life Scale.