Dear Holly,
First off, never second guess your path once you've taken it as believing in your chosen treatment is half the battle (at least, I think so). You went to a top notch hospital, one of the best in the world, and your surgeon is too. He would not have done robotic surgery unless he thought it would benefit you-this I'm 100% positive about.
It's true that not every person would qualify just as not every blc patient qualifies for bladder sparing, or for neobladders (for example).
There are no stats on Da Vinci for cystectomy yet, it's just too new. Laparoscopic cystectomy is also extremely new and the 4 yr stats are coming back and I'm sorry to say that the results have been less than expected, given the fact that they do hand pick people with single tumors, preferably stage 2 and in good general health, which would normally mean that the results should be outstanding.
I'm very reluctant to say something like this--not only has Pat had a laparoscopic RC but others as well (and doing fine, I might add). There are only something like 200 people on which to do follow up with after 4 yrs.
Both laparoscopic RC and DaVinci RC's are still highly experimental procedures and the long term benefits of Da Vinci is not yet defined. If your doctor didn't tell you this then he was remiss. Best would be if you were part of a clinical trial...but even if that wasn't the case, believe me, your experience will count. Actually, you're a pioneer making history and defining what may be the future of RC. Pat too.
The hardest part about doing this site, discussion group and this forum is the risk that I will upset or worry someone by reporting to the best of my knowledge, honestly about the state of things. I hope you accept my apology for causing you worry.
Please do ask lots of questions to your doctor and let us know what he says if you can.
Dan reported John Stein's and USC's review of laparoscopic RC's just coming in, I had this one as well, both are very recent, if you want I can send you the whole article in pdf form; an excerpt:
JULY 2007 VOL 4 NO 7 PUPPO ET AL. NATURE CLINICAL PRACTICE UROLOGY 393
www.nature.com/clinicalpractice/uro
Most series in which LRC has been studied
have included patients with fewer comorbidities
and lower-stage cancers than participants in
ORC[open RC] studies. Also, publications on LRC often do
not report the number of lymph nodes retrieved
during the procedures; consequently, there is a
dearth of that type of information. Some later
papers report a median number of nodes excised
within the range fixed as standard for ORC.
Overall, most of the information published
on LRC is devoted to the description of the
operative technique; follow-up data and
survival rates are generally lacking. In addition,
given the more favorable inclusion criteria for
participants in LRC than in ORC studies, the
disease-free survival of 80% at follow-up seems
to be inferior to that reported by major series
of ORC. Obviously, to assess adequately the
surgical safety and the extent of cancer control
achieved with LRC, studies must be done with
more-homogeneous cohorts and with cohorts
comprising a broader range of patients, along
with longer follow-up periods than those that
have been used to date.
LRC is expensive and time-consuming
[again, most people getting LRC and/or DaVinci spend just as long on the table as with regular RC, it is not a shorter surgery in spite of Pat's experience, and yours--w}, and
surgeons endure a long learning curve to master
the technique; therefore, the choice of urinary
diversion becomes limited. Meanwhile, advances
in ORC techniques have reduced blood loss and
duration of surgery. Before LRC can be advocated
for integration into clinical practice, the
effect of the degree of invasiveness on outcomes
needs to be compared for LRC and ORC. The
reduction in length of skin incisions by a few
centimeters in LRC does not justify an overhaul
of established urological surgical practice.
Further reductions in blood loss, consumption
of analgesics, and length of hospitalization,
might overcome the high cost of LRC instruments,
long operating times and the need for
dedicated teams of surgeons. So far, however,
the main advocated advantages of LRC—low
transfusion rate and short hospital stay—are
at best similar to those of ORC. Disadvantages
of LRC, such as worse oncologic outcomes and
the excessive use of nonorthotopic types of
diversion, might outweigh these advantages. (what he is saying here is that more people undergoing LRC get pouches or ileal conduits rather than neobladders, and neobladders are considered state of the art at this point in time)
■ The proportion of patients with orthotopic
neobladders and who remain disease free
seems to be suboptimal compared with
ORC, and might actually represent major
disadvantages of LRC
