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Bladder Cancer Requiring CystectomyNCT01157676

Open Vs Robotic-Assisted Radical Cystectomy: A Randomized Trial

A study testing Open radical cystectomy, Robotic assisted radical cystectomy and DaVinci robot in people with Bladder Cancer Requiring Cystectomy, run by University of Miami at 16 sites in United States.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

This is a multi-institutional, randomized trial evaluating oncologic, perioperative, and functional outcomes following two standard care procedures for radical cystectomy. The participants will have one of the standard care procedures as part of their care. Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Bladder Cancer Requiring Cystectomy
What is being tested?
Open radical cystectomy, Robotic assisted radical cystectomy and DaVinci robot
Could I receive a placebo?
No, everyone receives an active treatment
How many people
350 participants
Where
16 sitesUnited States
Study dates
Jul 2011to Dec 2018
Phase
Interventional
Are there results?
Yes, posted in the registrySummary in the doctors' view

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Patient must have biopsy proven bladder cancer. Official pathology report reviewed at the participating institution is required.
  • Bladder cancer must be clinical stage T1-T4, N0-1, M0. (AJCC 7th edition) or refractory cis (carcinoma in situ).

Who cannot join

  • Inability to give informed consent.
  • Prior major abdominal and pelvic open surgical procedures that would preclude a safe robotic approach, as determined by the treating surgeon.
  • At the discretion of the treating surgeon, any pre-existing condition such as severe chronic obstructive pulmonary disease that precludes a safe initiation or maintenance of pneumoperitoneum over a prolonged period of time and during surgery.
  • Age <18 or >99 years.
  • Pregnancy.

Trial locations and contacts

16 sites in 1 country.

16 sites in 1 country

United States16 sites
  • University of Michigan Health System

    Ann Arbor, Michigan, 48109

  • Brigham and Women's Hospital

    Boston, Massachusetts, 02115

  • University of North Carolina

    Chapel Hill, North Carolina, 27599

  • University of Virginia Health Science Center, Department of Urology

    Charlottesville, Virginia, 22908

  • University of Chicago Medical Center

    Chicago, Illinois, 60637

  • Ohio State University Medical Center

    Columbus, Ohio, 43210

  • Loyola University Medical Center

    Maywood, Illinois, 60153

  • University of Miami

    Miami, Florida, 33136

  • University of Minnesota

    Minneapolis, Minnesota, 55455

  • Vanderbilt University Medical Center

    Nashville, Tennessee, 37232

  • University of California, Irvine Medical Center (UC Irvine)

    Orange, California, 92868

  • Mayo Clinic Arizona

    Phoenix, Arizona, 85054

  • Mayo Clinic

    Rochester, Minnesota, 55905

  • The University of Texas Health Science Center at San Antonio, Medical Arts & Research Center

    San Antonio, Texas, 78229

  • Cancer Research and Biostatistics (Data Management and Statistical Office)

    Seattle, Washington, 98101

  • Stanford University

    Stanford, California, 94305

Other trials in United States

About this study

This is a multi-institutional, randomized trial evaluating oncologic, perioperative, and functional outcomes following two standard care procedures for radical cystectomy. The participants will have one of the standard care procedures as part of their care. The two procedures that will be followed are open radical cystectomy and robotic assisted radical cystectomy (RARC). Open cystectomy is considered to be the more traditional approach. While newer, RARC is considered to be equivalent to open surgery when it is performed by a trained robotics surgeon. The reported complication rates of RARC appear comparable to open surgery. This means there is no significant difference in the risk between the two standard procedures. However, despite these potential advantages, true comparison between the open and robotic technique with regards to long term cancer related and functional outcomes has not been accomplished because previous studies did not compare patients of equal health status. The researchers hope to learn whether or not patients undergoing RARC recover more quickly than or at the same rate as patients undergoing an open radical cystectomy while having non inferior cancer related outcomes. This study is funded by the National Institutes of Health (NIH).

Being tested
Open radical cystectomy, Robotic assisted radical cystectomy, DaVinci robot
Keywords
open cystectomy, robotic assisted radical cystectomy, bladder cancer
Medical subject headings
Urinary Bladder Neoplasms

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Open radical cystectomyProcedure or surgery

    Standard of care removal of urinary bladder.

  • Robotic assisted radical cystectomyProcedure or surgery

    Standard of care removal of urinary bladder using DaVinci robot.

  • DaVinci robotDevice

    DaVinci robotic surgical system.

Study groups in NCT01157676
Study groupRoleWhat they receive
Open cystectomyActive comparatorOpen cystectomy performed using an incision made just above or at the level of umbilicus to the pubic symphysis.
Receives: Procedure: Open radical cystectomy
Robotic assisted radical cystectomyActive comparatorRobotic assisted Radical Cystectomy (RARC) is accomplished by a robot assisted laparoscopic approach.
Receives: Procedure: Robotic assisted radical cystectomy; Device: DaVinci robot

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Percentage of Participants With 2-year Progression Free Survival (PFS)

    Progression will be determined by the treating physician using the Response Evaluation Criteria in Solid Tumors (RECIST) Version 1.1 criteria based on radiographic or pathological evidence of disease progression or death from disease.

    Measured: 24 months

  2. Number of Participants With Positive Margins

    Evaluated are the number of participants with positive surgical, bladder, and urethral margins. Positive margin is defined as presence of tumor cells at the edge of the dissected tissue.

    Measured: At time of cystectomy, approximately 1 hour.

  3. Number of Participants Requiring Lymph Node Dissection

    Evaluated are the number of participants requiring extended or standard lymph node dissection

    Measured: At time of cystectomy, approximately 1 hour

  4. Quality of Life (QOL) Outcomes

    Functional Assessment of Cancer Therapy- Vanderbilt Cystectomy Index (FACT-VCI) scores range is 0-168 which is sum of physical, emotional, wellbeing, and FACTS Bl Cys. higher scores=better QOL.

    Measured: at baseline, 3 month, and 6 months

  5. Number of Participants With Post-surgical Complications

    Post surgical complications will be evaluated using the Clavien grading system with scores ranging from 0-5 with the higher number indicating increased post-surgical complications.

    Measured: 90 days post operative

  6. Amount of Estimated Blood Loss (EBL) in ml

    Perioperative measures such as EBL will be evaluated by measuring the amount of participant blood loss in ml.

    Measured: At time of cystectomy, approximately 1 hour

  7. Number of Participants Requiring Blood Transfusion

    Number of participants requiring peri, intra, and post operative blood transfusion.

    Measured: At time of cystectomy, approximately 1 hour

  8. Number of Days of Post Operative Length of Hospital Stay

    Number of days of post operative length of hospital stay will be evaluated

    Measured: Day 10 post surgery

  9. Length of Operative Time

    Length of minutes of cystectomy procedure

    Measured: At time of cystectomy, approximately 1 hour

  10. Laboratory Values

    Serum Hemoglobin (Hb) and Albumin will be reported in grams per deciliters (g/dL)

    Measured: baseline, 6 weeks, 3 months, 6 months, 12 months, 24 months, 36 months

  11. Measures of Functional Independence as Assessed by the Activities of Daily Living (ADL) Questionnaire

    Participant reported ADL questionnaire is a 7 item questionnaire with scores ranging from 7-21 with a lower score indicating increased independence.

    Measured: baseline, 1 month , 3 months, 6 months

  12. Percentage of Participants With 3-year Progression Free Survival (PFS)

    Progression will be determined by the treating physician using the RECIST Version 1.1 criteria based on radiographic or pathological evidence of disease progression or death from disease.

    Measured: 3 years

  13. Quality of Life (QOL) Outcomes as Assessed by the Short Form 8 (SF-8) Questionnaire

    The SF-8 consists of two component summary scores; physical (PCS) and mental component summary (MCS). They are scored by weighting each score to a norm-based scoring model. The total scores will be reported as a percentile with higher score indicating better quality of health.

    Measured: baseline, 3 month, and 6 month

  14. Total Number of Participants Requiring Intra-operative Fluid Requirement

    Total number of participants requiring Intra-operative fluid requirement. (blood+plasma+platelets) Note: In robotic group 1 participant received both plasma and platelets and 1 other received platelets in addition to blood transfusion. In the open group 5 participants received plasma in addition to blood transfusion.

    Measured: At time of cystectomy, approximately 1 hour

  15. Total Postoperative Analgesic Requirements

    Total postoperative analgesic requirements in milli grams

    Measured: At time of cystectomy, approximately 1 hour

  16. Creatinine Value.

    Serum creatinine will be reported in milligrams per deciliters (mg/dL).

    Measured: baseline, 6 weeks, 3 months, 6 months, 12 months, 24 months, 36 months

  17. Measures of Functional Independence as Assessed by the Instrumental Activities of Daily Living (IADL) Questionnaire

    Participant reported IADL questionnaire is an 8 item questionnaire with scores ranging from 8-32 with a lower score indicating increased independence.

    Measured: baseline, 1 month, 3 months, 6 months

  18. Performance Related Measures of Functional Independence as Assessed by the Hand Grip Strength Test

    The hand grip strength test is measured in kilograms of pressure using a handheld dynamometer.

    Measured: baseline, 1 month, 3 months, 6 months

  19. Performance Related Measures of Functional Independence as Assessed by the Time Up and Go (TUG) Walking Test

    The TUG test is measured in seconds. Patients will be timed as they rise from a standard chair, walk 3 meters, turn, walk back, and sit again.

    Measured: baseline, 1 month, 3 months, 6 months

  20. Quality of Life (QOL) Outcomes as Assessed by the Functional Assessment of Cancer Therapy - Vanderbilt Cystectomy Index (FACT-VCI) Questionnaire

    FACT-VCI consists of eight domains: Five subscale scores (physical wellbeing, social wellbeing, emotional wellbeing, functional wellbeing, and FACT for patients with Bladder Cancer following Cystectomy [FACT-BL-Cys]) and three derived scores (trial outcome index), FACT-General form (FACT-G), and FACT-BL-Cys Total.The ranges of scores for each domain are as follows: 0-28 for physical, social, and functional wellbeing; 0-24 for emotional wellbeing; 0-60 for FACT-BL-Cys; 0-116 for FACT-VCI Trial Outcome Index (sum of physical wellbeing, functional wellbeing, and FACT-BL-Cys scores); 0-108 for FACT-G (sum of physical, social, emotional, and functional wellbeing scores); and 0-168 for FACT-BL-Cys Total (sum of physical, social, emotional, and functional wellbeing scores, and FACT-BL-Cys).The higher score indicates increased wellbeing.

    Measured: baseline, 3 months, 6 months

Secondary outcomes (1)
  1. Cost

    Fixed and variable costs associated with the procedure.

    Measured: Day 7

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted7 Jul 2010 (estimated)
  2. Study startJul 2011
  3. Primary completionDec 2018
  4. Study completionDec 2018

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Model description
Non inferiority phase 3 randomized clinical trial comparing robotic to open radical cystectomy
Masking
None (open label)
Enrolment
350 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT01157676
Sponsor's protocol ID
20120408
Other IDs
R01CA155388, 36911
Status last verified
Oct 2020
First submitted
30 Jun 2010
Last updated
3 Nov 2020
Data monitoring committee
Yes

Publications

  • Venkatramani V, Reis IM, Gonzalgo ML, Swain S, Svatek RS, Parekh DJ. Comparison of Complication and Readmission Rates Between Robot-Assisted and Open Radical Cystectomy: Results From the Randomized RAZOR Clinical Trial. J Urol. 2025 Jun;213(6):684-692. doi: 10.1097/JU.0000000000004497. Epub 2025 Mar 13.

    PubMed 40080805
  • Venkatramani V, Reis IM, Gonzalgo ML, Castle EP, Woods ME, Svatek RS, Weizer AZ, Konety BR, Tollefson M, Krupski TL, Smith ND, Shabsigh A, Barocas DA, Quek ML, Dash A, Parekh DJ. Comparison of Robot-Assisted and Open Radical Cystectomy in Recovery of Patient-Reported and Performance-Related Measures of Independence: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2022 Feb 1;5(2):e2148329. doi: 10.1001/jamanetworkopen.2021.48329.

    PubMed 35171260
  • Parekh DJ, Reis IM, Castle EP, Gonzalgo ML, Woods ME, Svatek RS, Weizer AZ, Konety BR, Tollefson M, Krupski TL, Smith ND, Shabsigh A, Barocas DA, Quek ML, Dash A, Kibel AS, Shemanski L, Pruthi RS, Montgomery JS, Weight CJ, Sharp DS, Chang SS, Cookson MS, Gupta GN, Gorbonos A, Uchio EM, Skinner E, Venkatramani V, Soodana-Prakash N, Kendrick K, Smith JA Jr, Thompson IM. Robot-assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer (RAZOR): an open-label, randomised, phase 3, non-inferiority trial. Lancet. 2018 Jun 23;391(10139):2525-2536. doi: 10.1016/S0140-6736(18)30996-6.

    PubMed 29976469

Questions about this trial

What is this clinical trial studying?

A study testing Open radical cystectomy, Robotic assisted radical cystectomy and DaVinci robot in people with Bladder Cancer Requiring Cystectomy, run by University of Miami at 16 sites in United States.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 2 inclusion and 5 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 3 Nov 2020. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 16 sites in United States. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

Yes. Results are posted in the registry (first posted 13 Jan 2020). A summary is in the For doctors view, and the full results are on ClinicalTrials.gov.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Percentage of Participants With 2-year Progression Free Survival (PFS) (time frame: 24 months). The study lists 20 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT01157676, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 3 Nov 2020.

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