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Robotic vs Open Cystectomy in Bladder Cancer?

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“How does robot-assisted radical cystectomy compare with traditional open radical cystectomy for management of patients with bladder cancer?

Robot-assisted radical cystectomy’s time may be here. Over the years I have read studies comparing robot-assisted surgery  to open surgery for prostatectomy, laryngectomy, mastectomy- and now comes a study comparing radical cystectomy- open vs robot. In every surgical procedure, robotic surgery starts slow but always catches up with open surgery.

The studies linked and excerpted below report what most studies I have read comparing robot-assisted to open surgery. At this point in time (10/18) there is not much difference between the two types of surgery.

What the studies don’t really discuss, because they’re studies comparing robotic to open, is that the newly diagnosed invasive bladder cancer patient considering open vs. robotic total cystectomy must consider 1) the institution/surgeon performing the procedure and 2) pre-habilitation before the procedure and 3) the anti-bladder cancer lifestyle after the procedure.

Let me explain. One of the most important questions a bladder cancer patient must ask the surgeon potentially doing the cystectomy is simply “how many cystectomies have you performed in the past year?” Nothing beats experience. While the Lancet study referred to below compared open vs. robotic surgury, it could be that in your area (city, town, region, etc.) one surgeon performing open cystectomies has much more experience than a different hospital with a deVinci surgical robot down the street. Your two choices may have very different success rates.

The term “pre-habilitation” refers to how the patient prepares for the upcoming procedure. Studies show that patients preparing for surgery, chemotherapy, etc. do better, aka recover faster, have fewer complications, etc. that if they don’t pre-habilitate.  It’s like getting in shape for the big game…

As for living an anti-bladder cancer lifestyle after your radical cystectomy, consider evidence-based nutrition, supplementation and lifestyle (frequent, moderate exercise) that research shows can reduce your risk of bladder cancer relapse. An exellent example is a nutritional supplement called curcumin. Research shows that curcumin supplementation reduces the risk of BC relapse. Scroll down the page to learn about the most bioavailable curcumin formulas.

Have you been diagnosed with invasive bladder cancer? Scroll down the page, post a question or comment and I will reply to you ASAP.

Thank you,

David Emerson

  • Cancer Survivor
  • Cancer Coach
  • Director PeopleBeatingCancer

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Cystectomy

Cystectomy is a medical term for surgical removal of all or part of the urinary bladder… The most common condition warranting removal of the urinary bladder is bladder cancer.[2]

Two main types of cystectomies can be performed. A partial cystectomy (also known as a segmental cystectomy) involves removal of only a portion of the bladder.[3] A radical cystectomy involves removal of the entire bladder along with surrounding lymph nodes and other nearby organs that contain cancer.[4]..”

Robotic vs Open Cystectomy: Which Fares Better for Bladder Cancer?

“How does robot-assisted radical cystectomy compare with traditional open radical cystectomy for management of patients with bladder cancer? To answer this question, the authors of a study published in the Lancet [1]performed a randomized trial comparing these two types of surgery in 350 patients randomly allocated to each method…

The study results showed a nonsignificant difference between the two methods: 72.3% (150) of patients treated with robotic surgery survived and were considered disease-free compared with 71.6% (152) of conventionally treated patients.

However, other important measures of outcome, such as blood loss, intraoperative transfusions, and hospital length of stay, were significantly better in the robot-assisted group…

There were no differences in surgical complication rates (P = .75), and robotic surgery offered significant benefit with respect to blood loss and reduced hospitalization. These significant advantages need to be balanced against the extra costs and the extra training required to learn this advanced technique.”

Robot-assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer (RAZOR): an open-label, randomised, phase 3, non-inferiority trial

“Radical cystectomy is the surgical standard for invasive bladder cancer. Robot-assisted cystectomy has been proposed to provide similar oncological outcomes with lower morbidity. We aimed to compare progression-free survival in patients with bladder cancer treated with open cystectomy and robot-assisted cystectomy…

Interpretation

In patients with bladder cancer, robotic cystectomy was non-inferior to open cystectomy for 2-year progression-free survival. Increased adoption of robotic surgery in clinical practice should lead to future randomised trials to assess the true value of this surgical approach in patients with other cancer types…”

The Most BioAvailable Curcumin Formulas

“Based on a review of these studies, it is evident that better bioavailability of formulated curcumin (CU) products is mostly attributed to improved solubility, stability, and possibly low first-pass metabolism”

A search of the Pubmed database for the word curcumin yields 601 studies spaning health topics from multiple myeloma and colorectal cancer, to chemotherapies that synergizes with CU, to Alzheimer’s Disease, arthritis and more. Based on years of reading studies and personal accounts, I think it is safe to say that CU supplementation is safe and relatively inexpensive.

I have read about myeloma patients taking daily doses of CU from 400 milligrams to 8 grams (1000 milligrams = 1 gram). By almost any measure, CU is a safe, inexpensive wonder drug.

The only challenge is that CU is famously difficult to absorb in the body. In other words, a person has to mix curcumin with some sort of fat (coconut oil, chocolate, etc.) or take a brand of curcumin capsule that is already formulated to be more “bioavailable” in order to derive the full benefit of CU.

The study linked and exerpted below reviews different formulations of CU. The study itself lists the three most bioavailable formulation/brand of CU and I’ve added an excerpt from a further review from Consumerlab.com that lists four additional bioavailable brands of CU.


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Curcumin

CU is a bright yellow chemical produced by some plants. It is the principal curcuminoid of turmeric (Curcuma longa), a member of the ginger family, Zingiberaceae. It is sold as an herbal supplement, cosmetics ingredient, food flavoring, and food coloring.[1]

Bioavailable curcumin formulations: A review of pharmacokinetic studies in healthy volunteers.

“Curcumin is a widely studied natural compound which has shown tremendous in vitro therapeutic potential. Despite that, the clinical efficacy of the native CU is weak due to its low bioavailability and high metabolism in the gastrointestinal tract. During the last decade, researchers have come up with different formulations with a focus on improving the bioavailability of curcumin. As a result, a significant number of bioavailable curcumin-based formulations were introduced with the varying range of enhanced bioavailability.

The purpose of this review is to collate the published clinical studies of CU products with improved bioavailability over conventional (unformulated) CU. Based on the literature search, 11 curcumin formulations with available human bioavailability and pharmacokinetics data were included in this review. Further, the data on clinical study design, analytical method, pharmacokinetic parameters and other relevant details of each formulation were extracted.

Based on a review of these studies, it is evident that better bioavailability of formulated curcumin products is mostly attributed to improved solubility, stability, and possibly low first-pass metabolism. The review hopes to provide a quick reference guide for anyone looking information on these bioavailable curcumin formulations.

Based on the published reports,

exhibited over 100-fold higher bioavailability relative to reference unformulated CU. Suggested mechanisms accounting for improved bioavailability of the formulations and details on the bioanalysis methods are also discussed.”

According to Consumerlab.com:

“Novasol has the highest bioavailability (185 x compared to unforumulated CU), followed by Curcuwin (136 x), Longvida (100 x), Meriva (48 x), BCM-95 (27 x), Curcumin C3 Complex + Bioperene (20 x), and then Theracumin (16 x).”

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