Muristek
Robot-Assisted Radical Cystectomy vs Open Radical Cystectomy and 90-Day Morbidity and Mortality Among Patients With Bladder Cancer
To the Editor We have several questions about the recent trial about robot-assisted vs open radical cystectomy for patients with bladder cancer. Given that neoadjuvant chemotherapy (NAC) is recommended for all patients with stage T2 and higher bladder cancer, we wonder whether the relatively low rate of NAC in this trial was a result of low-stage disease at diagnosis (eg, an indication for cystectomy of recurrent T1 disease rather than the more common indication of muscle-invasive disease), poor baseline kidney function in the patient population (which would preclude the use of platinum-based chemotherapy), or clinician preference to proceed directly to cystectomy. Perhaps the benefits of robotic surgery would be even more pronounced in a population with a higher percentage of the cohort having received NAC. Moreover, this article did not mention which type of NAC was used; we wonder how the choice of NAC affected the 16% to 18% of patients in this study with no tumor on grading. It would also be helpful to know the rates of adjuvant chemotherapy in each group, especially as earlier recovery (eg, more days out of the hospital) can lead to earlier adjuvant therapy.
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