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. 2021 Aug;26(8):1514-1523.
doi: 10.1007/s10147-021-01939-3. Epub 2021 May 19.

Intra-corporeal robot-assisted versus open radical cystectomy: a propensity score-matched analysis comparing perioperative and long-term survival outcomes and recurrence patterns

Kenji Zennami  1 , Makoto Sumitomo  2 , Kiyoshi Takahara  2 , Takuhisa Nukaya  2 , Masashi Takenaka  2 , Kosuke Fukaya  2 , Manabu Ichino  2 , Naohiko Fukami  3 , Hitomi Sasaki  2 , Mamoru Kusaka  3 , Ryoichi Shiroki  2
Affiliations

Intra-corporeal robot-assisted versus open radical cystectomy: a propensity score-matched analysis comparing perioperative and long-term survival outcomes and recurrence patterns

Kenji Zennami et al. Int J Clin Oncol. 2021 Aug.

Abstract

Background: To compare perioperative and long-term oncological outcomes and recurrence patterns between robot-assisted radical cystectomy with intra-corporeal urinary diversion (iRARC) and open radical cystectomy (ORC).

Methods: We retrospectively analyzed 177 bladder cancer patients who received iRARC or ORC at Fujita Health University between 2008 and 2020. Our primary endpoint was long-term oncological outcomes. As a secondary endpoint, we examined perioperative outcomes, complications, and recurrence patterns. These outcome measures were compared between the propensity score (PS)-matched cohorts.

Results: PS-matched analysis resulted in 60 matched pairs from iRARC and ORC groups. The iRARC cohort was associated with significantly longer operative time (p = 0.02), lower estimated blood loss (p < 0.001), lower blood transfusion rate (p < 0.001), shorter length of hospital stay (p < 0.001), fewer overall complications (p = 0.03), and lower rate of postoperative ileus (p = 0.02). There was no statistically significant difference between iRARC and ORC in 5-year RFS (p = 0.46), CSS (p = 0.63), and OS (p = 0.71). RFS and CSS were also comparable, even in locally advanced (≥ cT3) disease. Multivariate analysis identified lymphovascular invasion as a robust predictor of RFS, CSS, and OS. The number of recurrence was similar between the groups, while extra-pelvic lymph nodes were more frequent in iRARC than that in ORC (22.7% vs. 7.7%).

Conclusions: iRARC has favorable perioperative outcomes, fewer complications, and comparable long-term survival outcomes, including locally advanced (≥ cT3) disease, compared to that in ORC. Our results need to be validated in prospective randomized clinical trials.

Keywords: Bladder cancer; Intra-corporeal urinary diversion; Long-term survival; Open radical cystectomy; Recurrence; Robot-assisted radical cystectomy.

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