title: Patient-Reported Convalescence and Quality of Life Recovery: A Comparison of Open and Robotic-Assisted Radical Cystectomy.
abstract: Background Robotic-assisted radical cystectomy (RARC) is gaining traction as a surgical approach, but there are limited data on patient-reported outcomes for this technique compared to open radical cystectomy (ORC). Objective To compare health-related quality of life (HRQoL) and short-term convalescence among bladder cancer patients who underwent ORC and RARC. Methods Review of a single-institution bladder cancer database was conducted. Baseline and postoperative HRQoL was evaluated using the Bladder Cancer Index (BCI) for 324 patients who had ORC (n = 267) or RARC (n = 57) between 2008 and 2012. The BCI assesses function and bother in urinary, bowel, and sexual domains. Among 87 distinct patients (ORC n = 67, RARC n = 20), we also evaluated short-term postoperative convalescence using the Convalescence and Recovery Evaluation (CARE) questionnaire. Our primary outcomes were HRQoL within 12 months and short-term convalescence within 6 weeks following cystectomy. We fit generalized estimating equation regression models to estimate longitudinal changes in BCI scores within domains, and CARE domain score differences were tested with Wilcoxon rank-sum tests. Results Clinical characteristics and baseline BCI/CARE scores were similar between the 2 groups (all P > .05). Within 1 year after surgery, recovery of HRQoL across all BCI domains was comparable, with scores nearly returning to baseline at 1 year for all patients. CARE scores at 4 weeks revealed that patients treated with ORC had better pain (29.1 vs 20.0, P = .02) domain scores compared to RARC. These differences abated by week 6. Conclusions HRQoL recovery and short-term convalescence were similar in this cohort following ORC and RARC.
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Amy Y
authors.initials: AY
authors.lastname: Li
authors.affiliation: Emory University, Atlanta, GA, USA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Filson
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: John M
authors.initials: JM
authors.lastname: Hollingsworth
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Chang
authors.initials: C
authors.lastname: He
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Alon Z
authors.initials: AZ
authors.lastname: Weizer
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Brent K
authors.initials: BK
authors.lastname: Hollenbeck
authors.affiliation: H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
authors.forename: Scott M
authors.initials: SM
authors.lastname: Gilbert
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Khaled S
authors.initials: KS
authors.lastname: Hafez
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Cheryl T
authors.initials: CT
authors.lastname: Lee
authors.affiliation: University of Michigan, Ann Arbor, MI, USA.
authors.forename: Rodney L
authors.initials: RL
authors.lastname: Dunn
authors.affiliation: University of Michigan, Ann Arbor, MI, USA montrose@med.umich.edu.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Montgomery
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003289:Convalescence / Q000523:psychology*; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D007813:Laparotomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000503:physiopathology; D000071066:Patient Reported Outcome Measures; D011788:Quality of Life; D020127:Recovery of Function; D012189:Retrospective Studies; D018570:Risk Assessment; D065287:Robotic Surgical Procedures / Q000379:methods*; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*
keywords: evidence-based medicine/surgery; robotic surgery; urology