Dr Schmidt on the Role of Minimally Invasive and Robotic Modalities in Bladder Cancer

“Right now, with robotic cystectomy, there was a randomized trial published a couple of years ago that demonstrated an improvement in overall survival for patients who get a robotic cystectomy, and this was based on a decreased risk of death.”

Bogdana Schmidt, MD, MPH, an assistant professor in the Division of Urology at the University of Utah Huntsman Cancer Institute, discussed the role of minimally invasive and robotic modalities in patients with bladder cancer.

The utilization of minimally invasive and robotic-assisted surgeries has initiated a shift in the bladder cancer treatment paradigm, notably because it leads to a faster postsurgical recovery vs traditional surgery, Schmidt began. Past studies have even demonstrated an improvement in overall survival (OS) for patients who received robotic cystectomies for bladder cancer, she explained. Additionally, she noted that this improvement in OS was based on a decreased risk of death associated with blood clots, likely because patients can move around more independently following robotic surgery vs traditional surgery.

Furthermore, the phase 3 SWOG S1011 trial (NCT01224665) evaluated extended lymphadenectomies compared with standard lymphadenectomies in patients with localized muscle-invasive bladder cancer undergoing radical cystectomy, Schmidt continued. Historically, extended lymphadenectomies were performed after retrospective data established that this was the most beneficial modality, she explained. However, she emphasized that the phase 3 study changed the narrative and demonstrated that a standard lymphadenectomy was superior to extended lymphadenectomies because it was associated with less morbidity regarding blood clots. With studies such as this one, identifying and learning more about surgical strategies is essential, particularly as it relates to changing practice, Schmidt concluded.

Of note, the SWOG S1011 study randomly assigned patients 1:1 to undergo extended lymphadenectomy (n = 292) or standard lymphadenectomy (n = 300). At a median follow-up of 6.1 years, 45% vs 42% of patients from the extended lymphadenectomy and standard lymphadenectomy groups had experienced recurrence or death, respectively. At 5 years, the OS rates were 59% vs 63% in the respective groups (HR, 1.13; 95% CI, 0.88-1.45).