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Health related quality of life after radical cystectomy and urinary diversion. Open versus robotic assisted techniques.

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Sources of Funding: no funding

Introduction

Robotic assisted radical cystectomy and intra-corporeal diversion (iRARC) has evolved with aim to improve surgical outcomes and health related quality of life (HRQOL) of patients undergoing cystectomy. Gains in perioperative outcomes including surgical complication rate and length of stay are not apparent for iRARC when measured in the randomized controlled setting although transfusion rates are reduced. The impact of iRARC on HRQOL is not fully evaluated. We compared the HRQOL outcome of open radical cystectomy (ORC) vs iRARC in patients from two high volume centers.

Methods

The study included 101 patients for whom RC and urinary diversion (52 ORC and 49 iRARC) was carried out between Jun 2011 and January 2015. All patients were disease free and completed at least 12 months of follow up. HRQOL was assessed using the European Organization for Research and Treatment of Cancer-QOL (EORTC-QLQ-C30) (English and validated Arabic version). Comparison of the HRQOL scales between both groups was performed using Mann-Whitney U test.

Results

The mean age for patients undergoing iRARC and ORC was 66.3 and 54.1 years, respectively. The median (range) postoperative follow up for iRARC and ORC groups was 27(17-60) and 43 (13-65) months, respectively. The iRARC group included 37 males and 12 females for whom intracorporeal orthotopic neobladder (ONB) (n=15) and ileal conduit (IC) (n=35) were performed. ORC included 31 males and 21 females for whom ONB and IC were performed in 41 and 11 patients, respectively. There was a significant difference in global health status (QL2) for iRARC in comparison to ORC (median (range)) [75(0-100) vs 33.3(0-100), p= 0.003] and a difference across functional scales for iRARC in comparison to ORC group (p<0.05). Also, iRARC showed statistically significant lower symptom scales in comparison to ORC groups (p<0.05). (Figure 1)

Conclusions

iRARC seems to provide patients with a better HRQOL compared to ORC. Large prospective studies including matched groups are still needed to assess HRQOL in these patients. However, our results suggest that HRQOL is an important outcome measure when assessing the potential benefits of iRARC and ORC._x000D_

Funding

no funding

Authors
Mohamed H Zahran
Mohammed Abozaid
Diaa-eddin Taha
Benjamin Lamb
Ashwin Sridhar
Wei Shen Tan
Khaled Almekaty
Ahmed S El Hefnawy
Bedeir Ali-El-Dein.
John Kelly
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