Mr. Roboto.

Cystectomy has been the mainstay of treatment for invasive bladder cancer for...ever. The phase 3 RAZOR trial enrolled 350 patients with bladder cancer of all types (cT1-4N0-1 or even cTis if recurrent) as long as they were candidates for radical cystectomy and randomized them to an open versus robotic approach. The primary endpoint assessed non-inferiority of disease-free survival (DFS) at 2 years with the robotic versus open approach, which was achieved at a rate of 72% each in the per-protocol analysis (n=302). What else was the same? Rates of adverse events (67-69%), making it less clear there is anything inherently superior with what is likely a more expensive surgery. An interesting side note is that only about a third of patients received neoadjuvant chemo despite its category 1 recommendation. TBL: You don’t lose out on any DFS outcomes with robotic versus open approaches to radical cystectomy for the treatment of bladder cancer, but verdict is still out on which approach is actually superior all things considered. Domo arigato. | Parekh, Lancet 2018