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SamenvattingIntroductie Ondanks de toenemende inzet van de robotgeassisteerde radicale cystectomie (RARC) is er weinig bekend over de kosteneffectiviteit van deze behandeling. Wij onderzochten in twee onafhankelijke centra de verschillen in totale kosten (tot 90 dagen postoperatief) tussen RARC en open radicale cystectomie (ORC). Materiaal en methoden Retrospectieve analyse van alle cystectomieën die tussen januari 2010 en sep. 2013 in het Rijnstate (Arnhem) en alle cystectomieën die tussen januari 2008 en januari 2014 in het Maasstad Ziekenhuis (Rotterdam) uitgevoerd werden. Resultaten Er werden 69 ORC's en 100 RARC's geïnclu-deerd. Binnen de Rijnstate-groep was RARC 6,5 % goedkoper dan ORC, met een trend tot 21 % goedkoper aan het einde van de serie. Binnen de Maasstad-groep was RARC 17 % goedkoper dan ORC. Conclusie Beide retrospectieve kostenanalyses laten zien dat RARC, inclusief materiële en operationele kosten, niet duurder is dan ORC. Deze resultaten dienen bevestigd te worden in een prospectieve vergelijkende studie. Trefwoorden robotgeassisteerde radicale cystectomie (RARC) · open radicale cystectomie (ORC) · kosteneffectiviteit · complicaties · leercurve drs. P. J. Stelwagen ( ) · drs. C. J. Wijburg afdeling Urologie, Rijnstate Ziekenhuis Total costs of open versus robot assisted radical cystectomy up to 90 days postoperative: a retrospective study of two centers with 169 patients Abstract Introduction Despite the increasing application of the robot in radical cystectomy (RARC), little is known about the cost-effectiveness. By means of series in two hospitals we analysed the difference in total costs up to 90 days postoperative between RARC and open cystectomy (ORC). Materials and methods Retrospective analysis of all cystectomies in the Maasstad hospital (Rotterdam, the Netherlands).Results In total 69 ORC and 100 RARC were included. Within Rijnstate RARC total costs were 6.5 % lower than ORC, with a trend towards 21 % lower costs towards the end of their series. Within Maasstad RARC was 17 % cheaper than their ORC. Conclusion Both retrospective analyses show that RARC, including all extra costs for materials and operational costs, was not more expensive than ORC. These results need to be confirmed in a prospective comparative study.

and two patients underwent incision of bladder neck contracture, all !2 years post-RP. Mean EPIC urinary incontinence scores at baseline, post-SBRT/pre-RP, 3 months, and 24 months post-RP were 90 (82-99), 91 (84-97), 14 (5-22), and 42 (17-68), respectively. No patients reported using pads pre-RP, while 92% and 75% used at least one pad per day at per day at 12 months and 24 months post-RP. Half of men had baseline erections suitable for intercourse which decreased to 0% post-RP and remained 0% to 24 months post-RP. SBRT resulted in negative surgical margins in 100% of patients, but biochemical recurrence occurred in seven patients (43%).CONCLUSIONS: Despite high radiographic and pathologic response, neoadjuvant SBRT to 30-35 Gy in 5 fractions followed by RP results in unacceptably high toxicity, severe QoL declines, and high recurrence rates. Our results highlight the importance of systemic therapy in the management of locally advanced prostate cancer. Ongoing trials of definitive SBRT and systemic therapy without RP are ongoing (NCT04194554).