Robotic Assisted Radical Cystectomy vs Open Radical Cystectomy: Systematic Review and Meta-Analysis

No AccessJournal of UrologyAdult Urology1 Apr 2019Robotic Assisted Radical Cystectomy vs Open Radical Cystectomy: Systematic Review and Meta-Analysis Niranjan J. Sathianathen, Arveen Kalapara, Mark Frydenberg, Nathan Lawrentschuk, Christopher J. Weight, Dipen Parekh, and Badrinath R. Konety Niranjan J. SathianathenNiranjan J. Sathianathen *Correspondence: 420 Delaware St. Southeast, MMC 394, Department of Urology, University of Minnesota, Minnesota55414 (telephone: 660-334-0774; FAX: 612-626-0428; e-mail: E-mail Address: [email protected]). Department of Urology, University of Minnesota, Minneapolis, Minnesota Department of Surgery, University of Melbourne, Melbourne, Australia , Arveen KalaparaArveen Kalapara Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia , Mark FrydenbergMark Frydenberg Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia , Nathan LawrentschukNathan Lawrentschuk Department of Urology, University of Minnesota, Minneapolis, Minnesota Department of Surgery, University of Melbourne, Melbourne, Australia , Christopher J. WeightChristopher J. Weight , Dipen ParekhDipen Parekh Department of Urology, University of Miami, Miami, Florida , and Badrinath R. KonetyBadrinath R. Konety View All Author Informationhttps://doi.org/10.1016/j.juro.2018.10.006AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: We performed an updated systematic review and meta-analysis of outcomes important to patients in those undergoing robot-assisted and open radical cystectomy. Materials and Methods: Multiple scientific databases were searched up to July 2018 for randomized, controlled trials comparing robot-assisted and open radical cystectomy. The primary outcomes of interest were disease progression, major (Clavien III-V) complications and 90-day quality of life. The quality of evidence was evaluated according to the framework in the Cochrane Handbook for Systematic Reviews of Interventions. Results: Five studies with a total of 540 participants were included in this review. There was no difference between robot-assisted and open radical cystectomy in disease progression (RR 0.94, 95% CI 0.69–1.29), major complications (RR 1.06, 95% CI 0.75–1.49) or quality of life (standardized mean difference –0.03, 95% CI –0.27–0.21). However, robot-assisted radical cystectomy demonstrated a reduced risk of perioperative blood transfusion (RR 0.58, 95% CI 0.43–0.80) and a marginally shorter hospital stay (RR –0.63 days, 95% CI –1.21–0.05). Operative time was longer in the robot-assisted group (mean difference 68.51 minutes, 95% CI 30.55–105.48). There was no statistically significant difference in local recurrence rates between the procedures (RR 2.08, 95% CI 0.96–4.50) but this difference may be clinically significant and it favored open radical cystectomy. The overall quality of evidence was judged to be moderate. Conclusions: Surgical approach does not have a considerable impact on oncologic, safety and quality of life outcomes in patients who undergo radical cystectomy. The benefits conferred by robot-assisted radical cystectomy are a decreased need for blood transfusion and earlier hospital discharge. References 1. : Trends in the diffusion of robotic surgery: a retrospective observational study. Int J Med Robot 2017; 13: e1870. Google Scholar 2. : Patterns-of-care and health economic analysis of robot-assisted radical prostatectomy in the Australian public health system. BJU Int 2015; 117: 930. Google Scholar 3. : Robotic surgery: a current perspective. Ann Surg 2004; 239: 14. Google Scholar 4. : Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: early outcomes from a randomised controlled phase 3 study. Lancet 2016; 388: 1057. 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Link, Google Scholar The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. Supported by the Cloverfields Foundation and The Institute for Prostate and Urologic Cancers, University of Minnesota (NJS). No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Editor's Note: This article is the second of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 822 and 823. © 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetailsCited byMastroianni R, Ochoa Arvizo M, Torregiani G and Simone G (2022) Robot-assisted vs Open Radical Cystectomy: Randomized Controlled Trials Lights and ShadowsJournal of Urology, VOL. 209, NO. 3, (460-461), Online publication date: 1-Mar-2023.Loizzo D, Pandolfo S and Autorino R (2022) Editorial CommentJournal of Urology, VOL. 207, NO. 5, (991-992), Online publication date: 1-May-2022.Zhang J, Ericson K, Thomas L, Knorr J, Khanna A, Crane A, Mittal R, Zampini A, Fascelli M, Murthy P, Haber G and Lee B (2019) Large Single Institution Comparison of Perioperative Outcomes and Complications of Open Radical Cystectomy, Intracorporeal Robot-Assisted Radical Cystectomy and Robotic Extracorporeal ApproachJournal of Urology, VOL. 203, NO. 3, (512-521), Online publication date: 1-Mar-2020.Smith J (2019) This Month in Adult UrologyJournal of Urology, VOL. 201, NO. 4, (637-638), Online publication date: 1-Apr-2019. Volume 201Issue 4April 2019Page: 715-720Supplementary Materials Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.Keywordsbladder neoplasmscystectomycomplicationsrobotic surgical proceduresquality of lifeMetricsAuthor Information Niranjan J. Sathianathen Department of Urology, University of Minnesota, Minneapolis, Minnesota Department of Surgery, University of Melbourne, Melbourne, Australia *Correspondence: 420 Delaware St. Southeast, MMC 394, Department of Urology, University of Minnesota, Minnesota55414 (telephone: 660-334-0774; FAX: 612-626-0428; e-mail: E-mail Address: [email protected]). More articles by this author Arveen Kalapara Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia More articles by this author Mark Frydenberg Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia More articles by this author Nathan Lawrentschuk Department of Urology, University of Minnesota, Minneapolis, Minnesota Department of Surgery, University of Melbourne, Melbourne, Australia More articles by this author Christopher J. Weight More articles by this author Dipen Parekh Department of Urology, University of Miami, Miami, Florida More articles by this author Badrinath R. Konety More articles by this author Expand All The corresponding author certifies that, when applicable, a statement(s) has been included in the manuscript documenting institutional review board, ethics committee or ethical review board study approval; principles of Helsinki Declaration were followed in lieu of formal ethics committee approval; institutional animal care and use committee approval; all human subjects provided written informed consent with guarantees of confidentiality; IRB approved protocol number; animal approved project number. Supported by the Cloverfields Foundation and The Institute for Prostate and Urologic Cancers, University of Minnesota (NJS). No direct or indirect commercial, personal, academic, political, religious or ethical incentive is associated with publishing this article. Editor's Note: This article is the second of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 822 and 823. Advertisement PDF downloadLoading ...