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Published in: BMC Cancer 1/2018

Open Access 01-12-2018 | Study protocol

Robot assisted radical cystectomy versus open radical cystectomy in bladder cancer (RACE): study protocol of a non-randomized comparative effectiveness study

Authors: C. J. Wijburg, C. T. J. Michels, J. R. Oddens, J. P. C. Grutters, J. A. Witjes, M. M. Rovers

Published in: BMC Cancer | Issue 1/2018

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Abstract

Background

Despite the fact that the cost-effectiveness of robot-assisted radical cystectomy (RARC) is not yet proven, and open radical (ORC) cystectomy is recommended as the standard of care in patients with high-risk non-muscle-invasive and muscle-invasive bladder cancer, the use of RARC is still increasing. The objective of the current ongoing comparative effectiveness trial therefore is to study the (cost-)effectiveness of RARC compared to ORC, both in terms of objective (complication rates, oncological outcomes) and patient-reported (health-related quality of life) outcome measures.

Methods

This study is designed as a non-randomized, multicentre comparative effectiveness trial.
Centres with an annual caseload of > 20 radical cystectomies can include patients after informed consent has been given. Centres that perform RARC must have passed the (initial) learning curve of 40 cases. A total of 338 (2 × 169) patients will be enrolled from 23 participating centres (12 ORC, 10 RARC and 1 LRC). Follow-up visits will be scheduled at 1, 3, 6 and 12 months. During each follow-up visit, clinical data and health-related quality of life questionnaires will be administered. Costs will be studied using a monthly resource usage questionnaire. Impact on complications and quality of life will be calculated as the average difference between the groups with 95% confidence intervals, adjusted for potential baseline differences by means of propensity score matching.

Discussion

This study aims to contribute to the development of evidence-based guidelines regarding the most cost-effective surgical technique for radical cystectomy.

Trial registration

Nederlands Trial Register/Dutch Trial Registry, trial identifying number: NTR5362. Registered on 14 August 2015. (http://​www.​trialregister.​nl/​trialreg/​admin/​rctview.​asp?​TC=​5362).
Literature
1.
go back to reference Alfred Witjes J, Lebret T, Compérat EM, Cowan NC, De Santis M, Bruins HM, Hernández V, Espinós EL, Dunn J, Rouanne M, Neuzillet Y, Veskimäe E, van der Heijden AG, Gakis G, Ribal MJ. Updated 2016 EAU guidelines on muscle-invasive and metastatic bladder Cancer. Eur Urol. 2017;71:462–75.CrossRefPubMed Alfred Witjes J, Lebret T, Compérat EM, Cowan NC, De Santis M, Bruins HM, Hernández V, Espinós EL, Dunn J, Rouanne M, Neuzillet Y, Veskimäe E, van der Heijden AG, Gakis G, Ribal MJ. Updated 2016 EAU guidelines on muscle-invasive and metastatic bladder Cancer. Eur Urol. 2017;71:462–75.CrossRefPubMed
2.
go back to reference Novara G, Catto JWF, Wilson T, Annerstedt M, Chan K, Murphy DG, Motttrie A, Peabody JO, Skinner EC, Wiklund PN, Guru KA, Yuh B. Systematic review and cumulative analysis of perioperative outcomes and complications after robot-assisted radical cystectomy. Eur Urol. 2015;67:376–401.CrossRefPubMed Novara G, Catto JWF, Wilson T, Annerstedt M, Chan K, Murphy DG, Motttrie A, Peabody JO, Skinner EC, Wiklund PN, Guru KA, Yuh B. Systematic review and cumulative analysis of perioperative outcomes and complications after robot-assisted radical cystectomy. Eur Urol. 2015;67:376–401.CrossRefPubMed
3.
go back to reference Musch M, Janowski M, Steves A, Roggenbuck U, Boergers A, Davoudi Y, Loewen H, Groeben H, Kroepfl D. Comparison of early postoperative morbidity after robot-assisted and open radical cystectomy: results of a prospective observational study. BJU Int. 2014;113:458–67.CrossRefPubMed Musch M, Janowski M, Steves A, Roggenbuck U, Boergers A, Davoudi Y, Loewen H, Groeben H, Kroepfl D. Comparison of early postoperative morbidity after robot-assisted and open radical cystectomy: results of a prospective observational study. BJU Int. 2014;113:458–67.CrossRefPubMed
4.
go back to reference Cookson MS, Chang SS, Wells N, Parekh DJ, Smith JA. Complications of radical cystectomy for nonmuscle invasive disease: comparison with muscle invasive disease. J Urol. 2003;169:101–4.CrossRefPubMed Cookson MS, Chang SS, Wells N, Parekh DJ, Smith JA. Complications of radical cystectomy for nonmuscle invasive disease: comparison with muscle invasive disease. J Urol. 2003;169:101–4.CrossRefPubMed
5.
go back to reference Shabsigh A, Korets R, Vora KC, Brooks CM, Cronin AM, Savage C, Raj G, Bochner BH, Dalbagni G, Herr HW, Donat SM. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol. 2009;55:164–74.CrossRefPubMed Shabsigh A, Korets R, Vora KC, Brooks CM, Cronin AM, Savage C, Raj G, Bochner BH, Dalbagni G, Herr HW, Donat SM. Defining early morbidity of radical cystectomy for patients with bladder cancer using a standardized reporting methodology. Eur Urol. 2009;55:164–74.CrossRefPubMed
6.
go back to reference Konety BR, Allareddy V, Herr H. Complications after radical cystectomy: analysis of population-based data. Urology. 2006;68:58–64.CrossRefPubMed Konety BR, Allareddy V, Herr H. Complications after radical cystectomy: analysis of population-based data. Urology. 2006;68:58–64.CrossRefPubMed
7.
go back to reference Yu H-Y, Hevelone ND, Lipsitz SR, Kowalczyk KJ, Nguyen PL, Choueiri TK, Kibel AS, Hu JC. comparative analysis of outcomes and costs following open radical cystectomy versus robot-assisted laparoscopic radical cystectomy: results from the US Nationwide inpatient sample. Eur Urol. 2012;61:1239–44.CrossRefPubMed Yu H-Y, Hevelone ND, Lipsitz SR, Kowalczyk KJ, Nguyen PL, Choueiri TK, Kibel AS, Hu JC. comparative analysis of outcomes and costs following open radical cystectomy versus robot-assisted laparoscopic radical cystectomy: results from the US Nationwide inpatient sample. Eur Urol. 2012;61:1239–44.CrossRefPubMed
8.
go back to reference van der Poel H, Stienen J, Wijsman B. Dutch national cystectomy quality registry report. Urograaf. 2016;6:2–5. van der Poel H, Stienen J, Wijsman B. Dutch national cystectomy quality registry report. Urograaf. 2016;6:2–5.
9.
go back to reference Leow JJ, Reese SW, Jiang W, Lipsitz SR, Bellmunt J, Trinh Q-D, Chung BI, Kibel AS, Chang SL. Propensity-matched comparison of morbidity and costs of open and robot-assisted radical cystectomies: a contemporary population-based analysis in the United States. Eur Urol. 2014;66:569–76.CrossRefPubMed Leow JJ, Reese SW, Jiang W, Lipsitz SR, Bellmunt J, Trinh Q-D, Chung BI, Kibel AS, Chang SL. Propensity-matched comparison of morbidity and costs of open and robot-assisted radical cystectomies: a contemporary population-based analysis in the United States. Eur Urol. 2014;66:569–76.CrossRefPubMed
10.
go back to reference Yuh B, Wilson T, Bochner B, Chan K, Palou J, Stenzl A, Montorsi F, Thalmann G, Guru K, Catto JWF, Wiklund PN, Novara G. Systematic review and cumulative analysis of oncologic and functional outcomes after robot-assisted radical cystectomy. Eur Urol. 2015;67:402–22.CrossRefPubMed Yuh B, Wilson T, Bochner B, Chan K, Palou J, Stenzl A, Montorsi F, Thalmann G, Guru K, Catto JWF, Wiklund PN, Novara G. Systematic review and cumulative analysis of oncologic and functional outcomes after robot-assisted radical cystectomy. Eur Urol. 2015;67:402–22.CrossRefPubMed
11.
go back to reference Nix J, Smith A, Kurpad R, Nielsen ME, Wallen EM, Pruthi RS. Prospective randomized controlled trial of robotic versus open radical cystectomy for bladder cancer: perioperative and pathologic results. Eur Urol. 2010;57:196–201.CrossRefPubMed Nix J, Smith A, Kurpad R, Nielsen ME, Wallen EM, Pruthi RS. Prospective randomized controlled trial of robotic versus open radical cystectomy for bladder cancer: perioperative and pathologic results. Eur Urol. 2010;57:196–201.CrossRefPubMed
12.
go back to reference Parekh DJ, Messer J, Fitzgerald J, Ercole B, Svatek R. Perioperative outcomes and oncologic efficacy from a pilot prospective randomized clinical trial of open versus robotic assisted radical cystectomy. J Urol. 2013;189:474–9.CrossRefPubMed Parekh DJ, Messer J, Fitzgerald J, Ercole B, Svatek R. Perioperative outcomes and oncologic efficacy from a pilot prospective randomized clinical trial of open versus robotic assisted radical cystectomy. J Urol. 2013;189:474–9.CrossRefPubMed
13.
go back to reference Bochner BH, Dalbagni G, Sjoberg DD, Silberstein J, Keren Paz GE, Donat SM, Coleman JA, Mathew S, Vickers A, Schnorr GC, Feuerstein MA, Rapkin B, Parra RO, Herr HW, Laudone VP. Comparing open radical cystectomy and robot-assisted laparoscopic radical cystectomy: a randomized clinical trial. Eur Urol. 2015;67:1042–50.CrossRefPubMed Bochner BH, Dalbagni G, Sjoberg DD, Silberstein J, Keren Paz GE, Donat SM, Coleman JA, Mathew S, Vickers A, Schnorr GC, Feuerstein MA, Rapkin B, Parra RO, Herr HW, Laudone VP. Comparing open radical cystectomy and robot-assisted laparoscopic radical cystectomy: a randomized clinical trial. Eur Urol. 2015;67:1042–50.CrossRefPubMed
14.
go back to reference Khan MS, Gan C, Ahmed K, Ismail AF, Watkins J, Summers JA, Peacock JL, Rimington P, Dasgupta P, Single-centre A. Early phase randomised controlled three-arm trial of open, robotic, and laparoscopic radical cystectomy (CORAL). Eur Urol. 2016;69:613–21.CrossRefPubMed Khan MS, Gan C, Ahmed K, Ismail AF, Watkins J, Summers JA, Peacock JL, Rimington P, Dasgupta P, Single-centre A. Early phase randomised controlled three-arm trial of open, robotic, and laparoscopic radical cystectomy (CORAL). Eur Urol. 2016;69:613–21.CrossRefPubMed
15.
go back to reference Smith ND, Castle EP, Gonzalgo ML, Svatek RS, Weizer AZ, Montgomery JS, Pruthi RS, Woods ME, Tollefson MK, Konety BR, Shabsigh A, Krupski T, Barocas DA, Dash A, Quek ML, Kibel AS, Parekh DJ. The RAZOR (randomized open vs robotic cystectomy) trial: study design and trial update. BJU Int. 2015;115:198–205.CrossRefPubMedPubMedCentral Smith ND, Castle EP, Gonzalgo ML, Svatek RS, Weizer AZ, Montgomery JS, Pruthi RS, Woods ME, Tollefson MK, Konety BR, Shabsigh A, Krupski T, Barocas DA, Dash A, Quek ML, Kibel AS, Parekh DJ. The RAZOR (randomized open vs robotic cystectomy) trial: study design and trial update. BJU Int. 2015;115:198–205.CrossRefPubMedPubMedCentral
16.
go back to reference Shen Z, Sun Z. Systematic review and meta-analysis of randomised trials of perioperative outcomes comparing robot-assisted versus open radical cystectomy. BMC Urol. 2016;16:59.CrossRefPubMedPubMedCentral Shen Z, Sun Z. Systematic review and meta-analysis of randomised trials of perioperative outcomes comparing robot-assisted versus open radical cystectomy. BMC Urol. 2016;16:59.CrossRefPubMedPubMedCentral
17.
go back to reference Hayn MH, Hussain A, Mansour AM, Andrews PE, Carpentier P, Castle E, Dasgupta P, Rimington P, Thomas R, Khan S, Kibel A, Kim H, Manoharan M, Menon M, Mottrie A, Ornstein D, Peabody J, Pruthi R, Palou Redorta J, Richstone L, Schanne F, Stricker H, Wiklund P, Chandrasekhar R, Wilding GE, Guru KA. The learning curve of robot-assisted radical cystectomy: results from the international robotic cystectomy consortium. Eur Urol. 2010;58:197–202.CrossRefPubMed Hayn MH, Hussain A, Mansour AM, Andrews PE, Carpentier P, Castle E, Dasgupta P, Rimington P, Thomas R, Khan S, Kibel A, Kim H, Manoharan M, Menon M, Mottrie A, Ornstein D, Peabody J, Pruthi R, Palou Redorta J, Richstone L, Schanne F, Stricker H, Wiklund P, Chandrasekhar R, Wilding GE, Guru KA. The learning curve of robot-assisted radical cystectomy: results from the international robotic cystectomy consortium. Eur Urol. 2010;58:197–202.CrossRefPubMed
18.
go back to reference Hayn MH, Hellenthal NJ, Seixas-Mikelus SA, Mansour AM, Stegemann A, Hussain A, Guru KA. Is patient outcome compromised during the initial experience with robot-assisted radical cystectomy? Results of 164 consecutive cases. BJU Int. 2011;108:882–7.PubMed Hayn MH, Hellenthal NJ, Seixas-Mikelus SA, Mansour AM, Stegemann A, Hussain A, Guru KA. Is patient outcome compromised during the initial experience with robot-assisted radical cystectomy? Results of 164 consecutive cases. BJU Int. 2011;108:882–7.PubMed
19.
go back to reference Abboudi H, Khan MS, Guru KA, Froghi S, de Win G, Van Poppel H, Dasgupta P, Ahmed K. Learning curves for urological procedures: a systematic review. BJU Int. 2014;114:617–29.CrossRefPubMed Abboudi H, Khan MS, Guru KA, Froghi S, de Win G, Van Poppel H, Dasgupta P, Ahmed K. Learning curves for urological procedures: a systematic review. BJU Int. 2014;114:617–29.CrossRefPubMed
20.
go back to reference Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMedPubMedCentral Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.CrossRefPubMedPubMedCentral
21.
go back to reference Cookson MS, Dutta SC, Chang SS, Clark T, Smith JA, Wells N. Health related quality of life in patients treated with radical cystectomy and urinary diversion for urothelial carcinoma of the bladder: development and validation of a new disease specific questionnaire. J Urol. 2003;170:1926–30.CrossRefPubMed Cookson MS, Dutta SC, Chang SS, Clark T, Smith JA, Wells N. Health related quality of life in patients treated with radical cystectomy and urinary diversion for urothelial carcinoma of the bladder: development and validation of a new disease specific questionnaire. J Urol. 2003;170:1926–30.CrossRefPubMed
22.
go back to reference Gilbert SM, Dunn RL, Hollenbeck BK, Montie JE, Lee CT, Wood DP, Wei JT. Development and validation of the bladder Cancer index: a comprehensive, disease specific measure of health related quality of life in patients with localized bladder cancer. J Urol. 2010;183:1764–9.CrossRefPubMed Gilbert SM, Dunn RL, Hollenbeck BK, Montie JE, Lee CT, Wood DP, Wei JT. Development and validation of the bladder Cancer index: a comprehensive, disease specific measure of health related quality of life in patients with localized bladder cancer. J Urol. 2010;183:1764–9.CrossRefPubMed
23.
go back to reference van Reenen M, Janssen B: EQ-5D-5L User Guide. Basic Information on How to Use the EQ-5D-5L Instrument. Version 2.1, April 2015. 2015. van Reenen M, Janssen B: EQ-5D-5L User Guide. Basic Information on How to Use the EQ-5D-5L Instrument. Version 2.1, April 2015. 2015.
24.
go back to reference Bouwmans C, Hakkaart van Roijen L, Koopmanschap MA, Krol M, Severens H, Brouwer W: Handleiding iMTA Medical Cost Questionnaire (iMCQ). 2013. Bouwmans C, Hakkaart van Roijen L, Koopmanschap MA, Krol M, Severens H, Brouwer W: Handleiding iMTA Medical Cost Questionnaire (iMCQ). 2013.
25.
go back to reference Bouwmans C, Krol M, Severens H, Koopmanschap M, Brouwer W, Hakkaart-van Roijen L. The iMTA productivity cost questionnaire: a standardized instrument for measuring and valuing health-related productivity losses. Value Health. 2015;18:753–8.CrossRefPubMed Bouwmans C, Krol M, Severens H, Koopmanschap M, Brouwer W, Hakkaart-van Roijen L. The iMTA productivity cost questionnaire: a standardized instrument for measuring and valuing health-related productivity losses. Value Health. 2015;18:753–8.CrossRefPubMed
26.
go back to reference Schneeweiss S. Sensitivity analysis and external adjustment for unmeasured confounders in epidemiologic database studies of therapeutics. Pharmacoepidemiol Drug Saf. 2006;15:291–303.CrossRefPubMed Schneeweiss S. Sensitivity analysis and external adjustment for unmeasured confounders in epidemiologic database studies of therapeutics. Pharmacoepidemiol Drug Saf. 2006;15:291–303.CrossRefPubMed
27.
go back to reference Wyczółkowski M, Juszczak K, Rzepecki M, Drewniak T, Klima W. Studer orthotopic ileal bladder substitute construction – surgical technique and complication management: one-center and 12-year experience. Adv Med Sci. 2010;55:146–52.CrossRefPubMed Wyczółkowski M, Juszczak K, Rzepecki M, Drewniak T, Klima W. Studer orthotopic ileal bladder substitute construction – surgical technique and complication management: one-center and 12-year experience. Adv Med Sci. 2010;55:146–52.CrossRefPubMed
28.
go back to reference Caro JJ, Briggs AH, Siebert U, Kuntz KM. ISPOR-SMDM modeling good research practices task force: modeling good research practices--overview: a report of the ISPOR-SMDM modeling good research practices task force--1. Value Health. 2012;15:796–803.CrossRefPubMed Caro JJ, Briggs AH, Siebert U, Kuntz KM. ISPOR-SMDM modeling good research practices task force: modeling good research practices--overview: a report of the ISPOR-SMDM modeling good research practices task force--1. Value Health. 2012;15:796–803.CrossRefPubMed
29.
go back to reference Collins JW, Patel H, Adding C, Annerstedt M, Dasgupta P, Khan SM, Artibani W, Gaston R, Piechaud T, Catto JW, Koupparis A, Rowe E, Perry M, Issa R, McGrath J, Kelly J, Schumacher M, Wijburg C, Canda AE, Balbay MD, Decaestecker K, Schwentner C, Stenzl A, Edeling S, Pokupić S, Stockle M, Siemer S, Sanchez-Salas R, Cathelineau X, Weston R, et al. enhanced recovery after robot-assisted radical cystectomy: EAU robotic urology section scientific working group consensus view. Eur Urol. 2016;70:649–60.CrossRefPubMed Collins JW, Patel H, Adding C, Annerstedt M, Dasgupta P, Khan SM, Artibani W, Gaston R, Piechaud T, Catto JW, Koupparis A, Rowe E, Perry M, Issa R, McGrath J, Kelly J, Schumacher M, Wijburg C, Canda AE, Balbay MD, Decaestecker K, Schwentner C, Stenzl A, Edeling S, Pokupić S, Stockle M, Siemer S, Sanchez-Salas R, Cathelineau X, Weston R, et al. enhanced recovery after robot-assisted radical cystectomy: EAU robotic urology section scientific working group consensus view. Eur Urol. 2016;70:649–60.CrossRefPubMed
30.
go back to reference Messer JC, Punnen S, Fitzgerald J, Svatek R, Parekh DJ. Health-related quality of life from a prospective randomised clinical trial of robot-assisted laparoscopic vs open radical cystectomy. BJU Int. 2014;114:896–902.CrossRefPubMed Messer JC, Punnen S, Fitzgerald J, Svatek R, Parekh DJ. Health-related quality of life from a prospective randomised clinical trial of robot-assisted laparoscopic vs open radical cystectomy. BJU Int. 2014;114:896–902.CrossRefPubMed
Metadata
Title
Robot assisted radical cystectomy versus open radical cystectomy in bladder cancer (RACE): study protocol of a non-randomized comparative effectiveness study
Authors
C. J. Wijburg
C. T. J. Michels
J. R. Oddens
J. P. C. Grutters
J. A. Witjes
M. M. Rovers
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2018
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-018-4779-6

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