A preliminary oncologic outcome and postoperative complications in patients undergoing robot-assisted radical cystectomy: Initial experience

Abstract

PurposeRobot-assisted radical cystectomy (RARC) was originally intended to replace open radical cystectomy (ORC) as a minimally invasive surgery for patients with invasive bladder cancer. The purpose of this study was to evaluate the advantages of robotic surgery, comparing perioperative and oncologic outcomes between RARC and ORC.Materials and MethodsBetween June 2012 and August 2016, 49 bladder cancer patients were given a radical cystectomy, 21 robotically and 28 by open procedure. We compared the clinical variables between the RARC and ORC groups.ResultsIn the RARC group, the median estimated blood loss (EBL) during cystectomy, total EBL, operative time during cystectomy, and total operative time were 0 mL, 457.5 mL, 199 minutes, and 561 minutes, respectively. EBL during cystectomy (p<0.001), total EBL (p<0.001), and operative time during cystectomy (p=0.003) in the RARC group were significantly lower compared with the ORC group. Time to resumption of a regular diet (p<0.001) and length of stay (p=0.017) were also significantly shorter compared with the ORC group. However, total operative time in the RARC group (median, 561 minutes) was significantly longer compared with the ORC group (median, 492.5 minutes; p=0.015).ConclusionsThis Japanese study presented evidence that RARC yields benefits in terms of BL and time to regular diet, while consuming greater total operative time. RARC may be a minimally invasive surgical alternative to ORC with less EBL and shorter length of stay.

Comparison of perioperative complications and health‐related quality of life between robot‐assisted and open radical cystectomy: A systematic review and meta‐analysis

“…The general characteristics of the eligible studies are summarized in Table . The present systematic review includes six RCTs comprising 581 patients, and 31 NRCTs comprising 48 392 patients published between 2010 and 2018. Of these, 20 studies enrolled patients from North America, nine from Europe and eight from Asia.…”

Single staff cystectomy in a low-volume center: Oncological outcomes and complications

“…In our 10-year cohort, complications were reported in 89 patients with an overall complication rate of 56.3%. Although only 9 patients of this cohort underwent RARC, previous studies have shown that complication rates of ORC are comparable to those of RARC [4,18,20,21]. RARC has been proven equivalent to the open approach in terms of oncological and functional outcomes, with less blood loss, fewer transfusion, shorter hospital stays and quicker recovery [21].…”

“…Most of the available studies have analysed data from large population datasets or referral centers with high patient-and surgeonvolumes [5,[12][13][14][15][16], whereas a small number of reports deals with perioperative, oncological outcomes and complications in a low volume centers, where many RC are performed. Most of monocentric studies have focused their attention on specific surgical techniques or compared operative outcomes of different surgical approaches [18,19]. To our knowledge the current series represents the first report of outcomes of RC performed in a low-volume center by experienced surgeons that provides a comprehensive overview of results for different surgical techniques, reflecting the reality of most institutions.…”

Efficacy of the Addition of Robot-assisted Radical Cystectomy with Extracorporeal Urinary Diversion after an Enhanced Recovery Protocol

“…That nding might re ect the universal health reimbursement provided through employee-and community-based social health insurance in Japan and the existing local traditions [24]. In previous Japanese studies, Muto et [25,26]. Third, ERAS implementation at our institution involved only a few potential ERAS elements.…”