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Robotic or Open Radical Cystectomy in Treating Patients With Bladder Cancer

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ClinicalTrials.gov Identifier: NCT02699853
Recruitment Status : Recruiting
First Posted : March 4, 2016
Last Update Posted : May 2, 2018
Sponsor:
Collaborator:
National Cancer Institute (NCI)
Information provided by (Responsible Party):
University of Southern California

Brief Summary:
This randomized phase II trial studies how well robotic radical cystectomy (RRC) or open radical cystectomy (ORC) works in treating patients with bladder cancer. Cystectomy is a surgical procedure to remove all or part of the bladder (the organ that holds urine) or to remove a cyst (a sac or capsule in the body). In RRC, the the surgeon makes small cuts in the abdomen and uses a thin, lighted instrument with a camera attached called a scope. With the help of a robot, the surgeon removes the bladder and other nearby structures. In ORC, the surgeon makes a cut into the lower abdomen to expose the urinary tract in order to remove the bladder and nearby structures. It is not yet known whether RRC or ORC has fewer complications, better quality of life, and faster recovery time in treating patients with bladder cancer.

Condition or disease Intervention/treatment Phase
Stage 0is Bladder Urothelial Carcinoma Stage I Bladder Urothelial Carcinoma Stage II Bladder Urothelial Carcinoma Stage III Bladder Urothelial Carcinoma Other: Questionnaire Administration Procedure: Radical Cystectomy Not Applicable

Detailed Description:

PRIMARY OBJECTIVES:

I. To compare RRC to ORC in terms of the difference in European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire Core (QLQC)30 quality of life instrument assessed at baseline to day 30 after radical cystectomy (RC).

II. To compare RRC to ORC in terms of the 90-day high-grade complication rate (where high grade is defined as Clavien-Dindo grade 3-5).

III. To compare the peri-operative cost of the RC procedure, as defined as from the day of hospital admission to the day of hospital discharge.

SECONDARY OBJECTIVES:

I. To estimate the differences between RRC and ORC in terms of the following quality of life outcomes: Narcotic requirements prior to RC, during hospital stay and on days 7, 14, 30, 6 weeks, and 3, 6, 9 and 12 months; Visual Analog Scale (VAS) pain score prior to RC and on days 7, 14, 30, 6 weeks, and 3, 6, 9 and 12 months; the EORTC-QLQ-30 prior to RC and at 3, 6, 9, and 12 months; the bladder cancer index (BCI) at 30 days and 3, 6, 9, and 12 months; the Sexual Health Inventory for Men (SHIM) prior to RC and at 3, 6, 9, and 12 months; the World Health Organization (WHO) Quality of Life (QOL) questionnaire prior to RC and at 30 days and 3, 6, 9, and 12 months.

II. To estimate the differences between RRC and ORC in terms of the following surgical and complication outcomes: all complications occurring intraoperatively, during postoperative hospitalization and during the 90 days post cystectomy assessed at 7, 14, and 30 days; at 6 weeks and at 3 months-graded according to the Clavien-Dindo classification; all complications, all grade 3+ complications, and all grade 4+ complications; time to oral intake; estimated blood loss during surgery, number of transfusions on the day of surgery; drop in hematocrit at 24 hours; lymph node yield; and positive surgical margin.

III. To estimate the differences between RRC and ORC in terms of the following cost-related outcomes: operation room time; number of disposables used; pharmacy costs; length of hospital stay; admission to intensive care unit (ICU) prior to discharge & length of stay in ICU; number of hospital readmissions within 30 and 90 days (3 months); necessary tests/procedures to treat complications during hospitalization and within 30 and 90 days.

OUTLINE: Patients are randomized to 1 of 2 treatment arms.

ARM I: Patients undergo RRC at day 0.

ARM II: Patients undergo ORC at day 0.

After completion of study treatment, patients are followed up at 7 days, 30 days, 6 weeks, and at 3, 6, 9, and 12 months.


Study Type : Interventional  (Clinical Trial)
Estimated Enrollment : 208 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)
Primary Purpose: Supportive Care
Official Title: Prospective Randomized Comparison of Robotic Versus Open Radical Cystectomy
Actual Study Start Date : April 12, 2016
Estimated Primary Completion Date : October 12, 2019
Estimated Study Completion Date : October 12, 2020

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
Experimental: Arm I (RRC)
Patients undergo RRC at day 0.
Other: Questionnaire Administration
Ancillary studies

Procedure: Radical Cystectomy
Undergo RRC
Other Name: Complete Cystectomy

Experimental: Arm II (ORC)
Patients undergo ORC at day 0.
Other: Questionnaire Administration
Ancillary studies

Procedure: Radical Cystectomy
Undergo ORC
Other Name: Complete Cystectomy




Primary Outcome Measures :
  1. Change in patient reported quality of life, as measured by the EORTC-QLQ-C30 [ Time Frame: Baseline and 1-month post cystectomy ]
    The results for the two arms will be summarized using graphical methods and standard descriptive statistics. Means (or medians) and associated 95% confidence intervals-for each arm separately and for the difference-will be used to display the patterns. For QoL variables that are assessed at multiple times post cystectomy, regression methods that accommodate repeated measures will be used to assess patterns over time. Analyses will compare the two arms using general linear regression models and stratifying for the four variables used for stratification prior to randomization.


Secondary Outcome Measures :
  1. Change in erectile dysfunction, as measured by the SHIM score [ Time Frame: up to 12 months ]


Information from the National Library of Medicine

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Ages Eligible for Study:   Child, Adult, Older Adult
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • Indication for radical cystectomy for urothelial cancer
  • All types of urinary diversions
  • Tis-T3 Urothelial cancer; patients will be stratified according to clinical stage
  • Ability to consent
  • Patient meets criteria to be a surgical candidate

Exclusion Criteria:

  • Inability to give consent or adhere to follow-up schedule
  • T4 tumor
  • Bulky lymphadenopathy (> 2 cm)
  • Prior pelvic radiation
  • Not surgical candidate because of significant co-morbidity
  • Uncontrolled coagulopathy

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT02699853


Contacts
Contact: Ileana Aldana 323-865-0702 Ileana.aldana@med.usc.edu

Locations
United States, California
USC / Norris Comprehensive Cancer Center Recruiting
Los Angeles, California, United States, 90033
Contact: Mihir Desai, MD    323-865-3700    Mihir.Desai@med.usc.edu   
Principal Investigator: Mihir Desai         
Sponsors and Collaborators
University of Southern California
National Cancer Institute (NCI)
Investigators
Principal Investigator: Mihir Desai University of Southern California

Responsible Party: University of Southern California
ClinicalTrials.gov Identifier: NCT02699853     History of Changes
Other Study ID Numbers: 4B-15-4
NCI-2016-00080 ( Registry Identifier: CTRP (Clinical Trial Reporting Program) )
HS-15-00731
4B-15-4 ( Other Identifier: USC / Norris Comprehensive Cancer Center )
P30CA014089 ( U.S. NIH Grant/Contract )
First Posted: March 4, 2016    Key Record Dates
Last Update Posted: May 2, 2018
Last Verified: May 2017

Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No

Additional relevant MeSH terms:
Carcinoma
Carcinoma, Transitional Cell
Neoplasms, Glandular and Epithelial
Neoplasms by Histologic Type
Neoplasms