title: Health-related quality of life outcomes after robot-assisted and open radical cystectomy using a validated bladder-specific instrument: a multi-institutional study.
abstract: OBJECTIVE
  To evaluate health-related quality of life (HRQL) using validated bladder-specific Bladder Cancer Index (BCI) and European Organization for Research and Treatment of Cancer Body Image scale (BIS) between open radical cystectomy (ORC) and robot-assisted radical cystectomy (RARC).
  
  
  METHODS
  This was a retrospective case series of all patients who underwent radical cystectomy. Patients were grouped based on surgical approach (open vs robot assisted) and diversion technique (extracorporeal vs intracorporeal). Patients completed BCI and BIS preoperatively and at standardized postoperative intervals (at least 2). The primary exposure variable was surgical approach. The primary outcome measure was difference in interval and baseline BCI and BIS scores in each group. The Fisher exact, Wilcoxon rank-sum, and Kruskal-Wallis tests were used for comparisons.
  
  
  RESULTS
  Eighty-two and 100 patients underwent RARC and ORC, respectively. Compared with RARC, more patients undergoing ORC had an American Society of Anesthesiology score≥3 (66% vs 45.1% RARC; P=.007) and shorter median operative time (350 vs 380 minutes; P=.009). Baseline urinary, bowel, sexual function, and body image were not different between both the groups (P=1.0). Longitudinal postoperative analysis revealed better sexual function in ORC group (P=.047), with no significant differences between both the groups in the other 3 domains (P=.11, .58, and .93). Comparisons regarding diversion techniques showed similar findings in baseline and postoperative HRQL data, with no significant differences in the HRQL and body image domains.
  
  
  CONCLUSIONS
  RARC has comparable HRQL outcomes to ORC using validated BCI and BIS. The diversion technique used does not seem to affect patients' quality of life.
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Aboumohamed
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY.
authors.forename: Syed Johar
authors.initials: SJ
authors.lastname: Raza
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY.
authors.forename: Ali
authors.initials: A
authors.lastname: Al-Daghmin
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI.
authors.forename: Christopher
authors.initials: C
authors.lastname: Tallman
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY.
authors.forename: Terrance
authors.initials: T
authors.lastname: Creighton
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI.
authors.forename: Heather
authors.initials: H
authors.lastname: Crossley
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI.
authors.forename: Stephen
authors.initials: S
authors.lastname: Dailey
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY.
authors.forename: Aabroo
authors.initials: A
authors.lastname: Khan
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY.
authors.forename: Rakeeba
authors.initials: R
authors.lastname: Din
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY.
authors.forename: Diana
authors.initials: D
authors.lastname: Mehedint
authors.affiliation: Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY.
authors.forename: Katy
authors.initials: K
authors.lastname: Wang
authors.affiliation: Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY.
authors.forename: Yi
authors.initials: Y
authors.lastname: Shi
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Sharif
authors.affiliation: Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY.
authors.forename: Gregory
authors.initials: G
authors.lastname: Wilding
authors.affiliation: Department of Urology, University of Michigan, Ann Arbor, MI.
authors.forename: Alon
authors.initials: A
authors.lastname: Weizer
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY. Electronic address: khurshid.guru@roswellpark.org.
authors.forename: Khurshid A
authors.initials: KA
authors.lastname: Guru
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D015653:Cystectomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods* / Q000523:psychology; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000503:physiopathology / Q000628:therapy; D011788:Quality of Life; D012189:Retrospective Studies; D018570:Risk Assessment; D012371:Robotics / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000523:psychology* / Q000601:surgery*