Differences in recovery, oncological, and quality of life (QoL) outcomes between open radical cystectomy (ORC) and robot-assisted radical cystectomy (RARC) for patients with bladder cancer are unclear.
This review aims to compare these outcomes within randomized trials of ORC and RARC in this context. The primary outcome was the rate of 90-d perioperative events. The secondary outcomes included operative, pathological, survival, and health-related QoL (HRQoL) measures.
Systematic literature searches of MEDLINE, Embase, Web of Science, and clinicaltrials.gov were performed up to May 31, 2022.
Eight trials, reporting 1024 participants, were included. RARC was associated with a shorter hospital length of stay (LOS; mean difference [MD] 0.21, 95% confidence interval [CI] 0.03-0.39, p = 0.02) than and similar complication rates to ORC. ORC was associated with higher thromboembolic events (odds ratio [OR] 1.84, 95% CI 1.02-3.31, p = 0.04). ORC was associated with more blood loss (MD 322 ml, 95% CI 193-450, p < 0.001) and transfusions (OR 2.35, 95% CI 1.65-3.36, p < 0.001), but shorter operative time (MD 76 min, 95% CI 39-112, p < 0.001) than RARC. No differences in lymph node yield (MD 1.07, 95% CI -1.73 to 3.86, p = 0.5) or positive surgical margin rates (OR 0.95, 95% CI 0.54-1.67, p = 0.9) were present. RARC was associated with better physical functioning or well-being (standardized MD 0.47, 95% CI 0.29-0.65, p < 0.001) and role functioning (MD 8.8, 95% CI 2.4-15.1, p = 0.007), but no improvement in overall HRQoL. No differences in progression-free survival or overall survival were seen. Limitations may include a lack of generalization given trial patients.
RARC offers various perioperative benefits over ORC. It may be more suitable in patients wishing to avoid blood transfusion, those wanting a shorter LOS, or those at a high risk of thromboembolic events.
This study compares robot-assisted keyhole surgery with open surgery for bladder cancer. The robot-assisted approach offered less blood loss, shorter hospital stays, and fewer blood clots. No other differences were seen.
European urology. 2023 May 09 [Epub ahead of print]
Pramit Khetrapal, Joanna Kae Ling Wong, Wei Phin Tan, Thiara Rupasinghe, Wei Shen Tan, Stephen B Williams, Stephen A Boorjian, Carl Wijburg, Dipen J Parekh, Peter Wiklund, Nikhil Vasdev, Muhammad Shamim Khan, Khurshid A Guru, James W F Catto, John D Kelly
Division of Surgery & Interventional Sciences, University College London, London, UK; Department of Urology, Barts Health NHS Trust, London, UK; Department of Urology, University College London Hospital, London, UK. Electronic address: ., Department of Anaesthetics, Homerton University Hospital NHS Foundation Trust, London, UK; London School of Hygiene and Tropical Medicine, London, UK., Department of Urology, NYU Langone Health, New York, NY, USA., Division of Surgery & Interventional Sciences, University College London, London, UK., Division of Surgery & Interventional Sciences, University College London, London, UK; Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX, USA., Division of Urology, The University of Texas Medical Branch, Galveston, TX, USA., Department of Urology, Mayo Clinic, Rochester, Minnesota, MN, USA., Department of Urology, Rijnstate Hospital, Arnhem, The Netherlands., Desai Sethi Urology Institute at the Miller School of Medicine, University of Miami, Miami, FL, USA., Department of Urology, Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA., Department of Urology, Lister Hospital, East and North Hertfordshire NHS Trust, Stevenage, UK; School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire, UK., Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, London, UK., Department of Urology, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA., Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK; Department of Urology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK., Division of Surgery & Interventional Sciences, University College London, London, UK; Department of Urology, University College London Hospital, London, UK.
PubMed http://www.ncbi.nlm.nih.gov/pubmed/37169638