A dual-centre, cohort comparison of open, laparoscopic and robotic-assisted radical cystectomy

Khan, Mohammad Shamim; Challacombe, Benjamin; Elhage, Oussama; Rimington, Peter; Coker, Bola; Murphy, Declan; Grieve, Andy; Dasgupta, Prokar

doi:10.1111/j.1742-1241.2011.02888.x

Cited by 90 publications

(89 citation statements)

References 31 publications

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“…3). In two comparative nonrandomized studies between RARC and LRC, no significant differences in PSM rates were detected (p = 0.86) [87,89]. PLND, in conjunction with radical cystectomy, provides a staging benefit as well as a possible advantage for survival in retrospective studies.…”

Section: Potency Recovery After Robot-assisted Radical Cystectomymentioning

confidence: 99%

“…Exceptions included prospective studies [8,22,28,35,36,43,52,59,64,66,81,87] and some multi-institutional retrospective collaboration studies [16,23,25,30,45,48,54,61,68]. Only two of the comparative studies were randomized [74,83] (LOE 2b); all other comparative studies were nonrandomized, whether prospective or retrospective (LOE 4).…”

Section: Evidence Synthesismentioning

confidence: 99%

“…Only two series in this systematic review compared survival for RARC and ORC. These studies were not randomized and included sequential series of retrospective groups (LOE 4) [82,87]. In a series by Nepple et al, 36 patients who underwent RARC were compared with 29 patients who underwent ORC with a median follow-up of only 12 mo.…”

Section: Potency Recovery After Robot-assisted Radical Cystectomymentioning

confidence: 99%

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Systematic Review and Cumulative Analysis of Oncologic and Functional Outcomes After Robot-assisted Radical Cystectomy

et al. 2015

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Context: Although open radical cystectomy (ORC) is still the standard approach, laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) are increasingly performed.Objective: To report on a systematic literature review and cumulative analysis of pathologic, oncologic, and functional outcomes of RARC in comparison with ORC and LRC.Evidence acquisition: Medline, Scopus, and Web of Science databases were searched using a free-text protocol including the terms robot-assisted radical cystectomy or da Vinci radical cystectomy or robot* radical cystectomy. RARC case series and studies comparing RARC with either ORC or LRC were collected. A cumulative analysis was conducted.Evidence synthesis: The searches retrieved 105 papers, 87 of which reported on pathologic, oncologic, or functional outcomes. Most series were retrospective and had small case numbers, short follow-up, and potential patient selection bias. The lymph node yield during lymph node dissection was 19 (range: 3-55), with half of the series following an extended template (yield range: 11-55). The lymph node-positive rate was 22%. The performance of lymphadenectomy was correlated with surgeon and institutional volume. Cumulative analyses showed no significant difference in lymph node yield between RARC and ORC. Positive surgical margin (PSM) rates were 5.6% (1-1.5% in pT2 disease and 0-31% in pT3 and higher disease). PSM rates did not appear to decrease with sequential case numbers. Cumulative analyses showed no significant difference in rates of surgical margins between RARC and ORC or RARC and LRC.Neoadjuvant chemotherapy use ranged from 0% to 31%, with adjuvant chemotherapy used in 4-22% of patients. Only six series reported a mean follow-up of >36 mo. Three-year disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) rates were 53-74%, 68-83%, and 72-80%, respectively. The 5-yr DFS, CSS, and OS rates were 53-74%, 66-80%, and 39-66%, respectively. Similar to ORC, disease of higher pathologic stage or evidence of lymph node involvement was associated with worse survival. Very limited data were available with respect to functional outcomes. The 12-mo continence rates with continent diversion were 83-100% in men for daytime continence and 66-76% for nighttime continence. In one series, potency was recovered in 63% of patients who were evaluable at 12 mo. Conclusions

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Section: Potency Recovery After Robot-assisted Radical Cystectomymentioning

confidence: 99%

Section: Evidence Synthesismentioning

confidence: 99%

Section: Potency Recovery After Robot-assisted Radical Cystectomymentioning

confidence: 99%

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Systematic Review and Cumulative Analysis of Oncologic and Functional Outcomes After Robot-assisted Radical Cystectomy

et al. 2015

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“…Based on early experience, we estimated the RARC complication rate as 10-15% [15] and that for ORC as 25-60% [16]. Therefore, the number needed in each arm ranges from 43 to 58 so the 95% confidence interval (CI) for the estimated difference in rates is AE16%.…”

Section: Power Calculations and Statistical Analysismentioning

confidence: 99%

A Single-centre Early Phase Randomised Controlled Three-arm Trial of Open, Robotic, and Laparoscopic Radical Cystectomy (CORAL)

et al. 2016

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“…A single small randomized trial [34] and the majority of retrospective and prospective matched case-control studies have reported no difference in lymph node yield between open, laparoscopic, and/or robotic cystectomy [35][36][37], although some groups have reported higher nodal yield with the robotic approach [38 & ]. Comparative analysis of oncologic outcomes between open and minimally invasive cystectomy is confounded by selection bias as the majority of minimally invasive series had a small proportion of patients with nonorgan-confined disease and nodal metastases [39,40].…”

Section: Bladder Cancermentioning

confidence: 99%

Comparative effectiveness of minimally invasive versus open lymphadenectomy in urological cancers

Prasad

Shalhav

2013

Current Opinion in Urology

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A dual-centre, cohort comparison of open, laparoscopic and robotic-assisted radical cystectomy

Abstract: Despite study limitations, RARC had the lowest transfusion and complication rates and the shortest length of stay, although taking the longest to perform.

Cited by 90 publications

References 31 publications

Systematic Review and Cumulative Analysis of Oncologic and Functional Outcomes After Robot-assisted Radical Cystectomy

Systematic Review and Cumulative Analysis of Oncologic and Functional Outcomes After Robot-assisted Radical Cystectomy

A Single-centre Early Phase Randomised Controlled Three-arm Trial of Open, Robotic, and Laparoscopic Radical Cystectomy (CORAL)

Comparative effectiveness of minimally invasive versus open lymphadenectomy in urological cancers

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