Association of Open vs Robot-Assisted Radical Cystectomy With Mortality and Perioperative Outcomes Among Patients With Bladder Cancer in Sweden

Mortezavi, Ashkan; Crippa, Alessio; Kotopouli, Maria Ioanna; Akre, Olof; Wiklund, Peter; Hosseini, Abolfazl

doi:10.1001/jamanetworkopen.2022.8959

Cited by 24 publications

(17 citation statements)

References 36 publications

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“…The oncological outcome of the patients after radical cystectomy was independent of the surgical approach. Implementation of robotic surgery was neither able to improve recurrence free survival nor overall survival [4,7,8,9 ▪▪ ,10 ▪▪ ]. The 5-year relapse-free survival rate of the study populations of the above-mentioned trials ranged at about 60–70%, which could potentially be improved by a higher rate of neoadjuvant chemotherapy as recommended by the EAU [2 ▪ ].…”

Section: Interpreting Current Datamentioning

confidence: 97%

“…With a flat learning curve, Wijburg et al [13] showed that a stabile plateau of major complications and overall complications within 90 days after surgery for RARC+ICUD was reached after the high number of 137 surgeries per institution. The above-mentioned trials revealed a beneficial performance for RARC regarding intraoperative blood loss and perioperative transfusions and not only showed a trend towards faster recovery following RARC but also required significantly extended operation time compared with ORC [4,6 ▪▪ ,7,8,9 ▪▪ ,10 ▪▪ ]. Especially within the first weeks after surgery, patients undergoing RARC reported significantly improved general health related and cancer-specific health related quality of life [11].…”

Section: Interpreting Current Datamentioning

confidence: 98%

Section: Interpreting Current Datamentioning

confidence: 99%

“…Mortezavi et al [9 ▪▪ ] included registry-data data of propensity-score matched 2428 bladder cancer patients who received either RARC+ICUD or ORC from the Swedish National Register of Urinary Bladder Cancer in their analysis regarding mortality and perioperative outcomes. In 20.3% of the 874 participants in the RARC+ICUD cohort, urinary diversion was established as OBS, while urinary diversion in the ORC cohort was only accomplished as OBS in 7.5% of the 1554 participants.…”

Section: Open Vs Robotic Cystectomy – Current Evidence-based Datamentioning

confidence: 99%

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Robotic radical cystectomy – more precision needed?

Walz

Aslani

Sawodny

et al. 2022

Current Opinion in Urology

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Purpose of review Recently, several trials as well as registry-data analyses investigating the role of robot-assisted radical cystectomy with extra or intracorporal urinary diversion were completed and follow up matured. This review aims to comment on the current evidence-based findings and interpret the future role of the robotic approach as a part of the treatment of bladder cancer. Recent findings Numerous trials and registry-data analyses revealed no significant differences in progression-free and overall survival after open radical cystectomy or robot-assisted radical cystectomy irrespective of urinary diversion. Perioperative parameters, especially intraoperative blood loss, transfusions, thromboembolic events, wound infections and hospitalization were significantly increased in open radical cystectomy. Patients’ convalescence, and especially early postsurgical quality of life, was improved by the robotic approach. The highly demanding surgery itself displayed by a flat learning curve required more than 130 surgeries per institution to reach a stable plateau of complications. The performance of high-quality radical cystectomy irrespective of the approach was significantly increased in high-volume centres. Local recurrence occurs in 11% after radical cystectomy. Current research focuses on intraoperatively usable detection methods and instruments to minimize the risk of residual tumour cells. Summary Taken together, the total intracorporal approach in radical cystectomy holds the potential to improve perioperative parameters and reduces hospitalization without impairing oncological performance of the procedure. To provide best results for the patient radical cystectomy and especially the technically challenging total intracorporal procedure will gain importance in bladder cancer treatment but should be limited to high-volume centres.

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Section: Interpreting Current Datamentioning

confidence: 97%

Section: Interpreting Current Datamentioning

confidence: 98%

Section: Interpreting Current Datamentioning

confidence: 99%

Section: Open Vs Robotic Cystectomy – Current Evidence-based Datamentioning

confidence: 99%

See 2 more Smart Citations

Robotic radical cystectomy – more precision needed?

Walz

Aslani

Sawodny

et al. 2022

Current Opinion in Urology

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“…RARC offers advantages over open surgery, including reduced complications, shorter hospital stays, and faster recovery times 5–8 . Moreover, some studies have demonstrated that RARC yields better outcomes regarding recurrence‐free survival (RFS) and mortality rates 9,10 . However, the study of RARC in older adults remains controversial because most RARC studies include various urinary diversion methods, such as intra‐ and extracorporeal techniques, which can influence outcomes evaluation.…”

Section: Introductionmentioning

confidence: 99%

Older versus younger patients in robot‐assisted radical cystectomy with intracorporeal ileal conduit comparing safety and clinical outcomes

Sowanthip,

Zennami,

Bejrananda

et al. 2024

Int J of Urology

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ObjectiveTo evaluate the safety and efficacy of robot‐assisted radical cystectomy using an intracorporeal ileal conduit in older compared to younger patients.MethodsWe retrospectively analyzed 122 patients who underwent robot‐assisted radical cystectomy with an intracorporeal ileal conduit at Fujita Health University Hospital and Fujita Health University Okazaki Medical Center between 2012 and 2022. Patients were categorized into two groups: older (age ≥ 75 years; n = 53) and younger (age < 75 years; n = 69). Perioperative outcomes, complications, recurrence‐free survival, cancer‐specific survival, and overall survival were compared between the cohorts.ResultsThe groups had no significant differences in perioperative outcomes, such as estimated blood loss, operative time, and blood transfusion rate. However, hospital stay was longer in the older patients than in the younger group (19 vs. 16 days; p < 0.001). The 30‐day minor and major complication rates were 33.3% and 13.0%, respectively, for the younger group and 50.9% and 9.4% for the older group (p = 0.11). Urinary tract infection and bowel ileus were the most common complications in both groups. No significant differences were observed in recurrence‐free survival, cancer‐specific survival, and overall survival between the groups (p = 0.58, p = 0.75, and p = 0.78), and subgroup analysis in ≥cT3 revealed the older group tended to have poorer cancer‐specific survival and overall survival (p = 0.07 and p = 0.01). Multivariate analysis indicated that older age was not associated with high‐grade complications and cancer‐specific survival.ConclusionsRobot‐assisted radical cystectomy with an intracorporeal ileal conduit is a safe and effective treatment option for older patients.

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