EAU15: Robot-assisted radical cystectomy: still not the new standard

“Robot-assisted radical cystectomy (RARC) is feasible… but RARC cannot yet be considered as a standard treatment for invasive bladder cancer,” said Prof.Urs Studer (CH) who chaired the debate on robotic cystectomy versus open surgery.

“Regarding RARC, our initial expectations are not yet met. Why not? Because the surgeon makes the difference, not the instrument,” added Studer.The audience later gave him a standing ovation when session chairmen Profs. Hein van Poppel and Jean Palou announced it would be Studer’slast plenary participation in the annual congress.

Following the discussion and presentations by Bernard Bochner (USA) and N. Peter Wiklund (SE) who both provided insights and new data on the topic, Studer, however, noted that comparisons with open RC series may be misleading, and added this is also true for randomised trials for RARC versus open RC.

“Surgeon experience and institutional volume strongly predict favorable outcome after open RC or RARC. In general, results of large patient series are reported, but these masks negative results from the early learning curve,” Studer said.

Bochner, meanwhile, pointed out that doctor’s comfort with a particular technique can prove important. “Patients should also be asking the doctor what procedure he is comfortable with. In the end, it’s the doctors comfort which is key- and that could be my take-home message,” he said.

The experts were one in saying that oncological outcomes, one of the crucial factors, remain the same or are equal for both procedures. The clear advantages for RARC are less blood loss and transfusion rates, but which are counter-balanced by long operative time and high costs.

The session also presented two lectures which discussed molecular and genetic research in bladder and kidney cancers. Seth Lerner (USA) provided an update on the work of The Cancer Genome Atlas Project (TCGA), whilst Marco Gerlinger (GB) discussed the role of evolution and mutation in renal cell carcinoma. Noting that kidney cancer cells are highly prone to mutation which makes them unpredictable, the challenge for doctors is to closely track their patients and keep regular re-assessments of disease progression.