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. 2023 Sep 25;9(3):253-269.
doi: 10.3233/BLC-220065. eCollection 2023.

Comparison of Robotic vs Open Cystectomy: A Systematic Review

Niranjan J Sathianathen  1   2 , Henry Y C Pan  2 , Marc Furrer  2   3   4 , Benjamin Thomas  1   2 , Philip Dundee  2 , Niall Corcoran  1   2   5   6 , Christopher J Weight  7 , Badrinath Konety  8 , Rajesh Nair  4 , Nathan Lawrentschuk  1   2   6
Affiliations

Comparison of Robotic vs Open Cystectomy: A Systematic Review

Niranjan J Sathianathen et al. Bladder Cancer. .

Abstract

Background: The benefits of a robot-assisted radical cystectomy (RARC) compared to an open approach is still under debate. Initial data on RARC were from trials where urinary diversion was performed by an extracorporeal approach, which does not represent a completely minimally invasive procedure. There are now updated data for RARC with intracorporeal urinary diversion that add to the evidence profile of RARC.

Objective: To perform a systematic review and meta-analysis of the effectiveness of RARC compared with open radical cystectomy (ORC).

Materials and methods: Multiple databases were searched up to May 2022. We included randomised trials in which patients underwent RARC and ORC. Oncological and safety outcomes were assessed.

Results: Seven trials of 907 participants were included. There were no differences seen in primary outcomes: disease progression [RR 0.98, 95% CI 0.78 to 1.23], major complications [RR 0.95, 95% CI 0.72 to 1.24] and quality of life [SMD 0.05, 95% CI -0.13 to 0.38]. RARC resulted in a decreased risk of perioperative blood transfusion [RR 0.57, 95% CI 0.43 to 0.76], wound complications [RR 0.34, 95% CI 0.21 to 0.55] and reduced length of hospital stay [MD -0.62 days, 95% CI -1.11 to -0.13]. However, there was an increased risk of developing a ureteric stricture [RR 4.21, 95% CI 1.07 to 16.53] in the RARC group and a prolonged operative time [MD 70.4 minutes, 95% CI 34.1 to 106.7]. The approach for urinary diversion did not impact outcomes.

Conclusion: RARC is an oncologically safe procedure compared to ORC and provides the benefits of a minimally invasive approach. There was an increased risk of developing a ureteric stricture in patients undergoing RARC that warrants further investigation. There was no difference in oncological outcomes between approaches.

Keywords: Bladder cancer; complications; cystectomy; quality of life; robotic surgical procedures.

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Conflict of interest statement

Konety and Lawrentschuk are Editorial Board members of this journal, but were not involved in the peer-review process nor had access to any information regarding its peer-review. Sathianathen, Pan, Furrer, Thomas, Dundee, Corcoran, Weight and Nair have no conflict of interest to report.

Figures

Fig. 1
Fig. 1
Forest plots for: (A) major complications, (B) blood transfusion, (C) ureteric stricture, (D) thromboembolic events, (E) wound complications, (F) ileus. Legend: RARC = robot-assisted radical cystectomy; ORC = open radical cystectomy.
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See this image and copyright information in PMC

References

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