Current status and future perspective of robot‐assisted radical cystectomy for invasive bladder cancer

Abstract

The current status of robot‐assisted radical cystectomy was reviewed 16 years after the initial robot‐assisted radical cystectomy for the treatment of invasive bladder cancer. Articles associated with robot‐assisted radical cystectomy and written in English were selected from the PubMed database from January 2003 to February 2019. The present review article focused on the distribution of robot‐assisted radical cystectomy, patient selection, preoperative management, surgical technique, lymph node dissection, urinary diversion, recurrence pattern, oncological outcomes, cost, learning curve, complications and educational programs. A total of 400 articles were divided according to the country of the first author's affiliation. The USA was the most dominant at 198 (50%), whereas the number of articles from the countries belonging to the Urological Association of Asia was 15 (3.8%) for China, 17 (4.3%) for South Korea, 10 (2.5%) for Japan, eight (2%) for Taiwan, eight (2%) for Turkey and one (0.2%) for Iran. The percentage of robot‐assisted radical cystectomy carried out is increasing, and intracorporeal urinary diversion and ileal neobladder are also frequently carried out. With a refined technique being performed in high‐volume centers, robot‐assisted radical cystectomy has contributed to the reduction in transfusion rate, length of stay and severe complications; however, it has not yet shown any cancer‐specific survival benefits. Robot‐assisted radical cystectomy is not fully spread throughout the Urological Association of Asia. Further investigation with respect to worldwide results is needed to prove the real benefit of robot‐assisted radical cystectomy regarding low morbidity, reduced total medical cost, and survival benefit. In the era of precision medicine, appropriate drug and surgery will be given based on each genetic profile.

Oncological outcomes and recurrence patterns after laparoscopic radical cystectomy for bladder cancer: A Japanese multicenter cohort

“…The survival rate of LRC in the present study was almost comparable to that of MIRC (LRC or RARC) or that of ORC, as previously reported . In accordance with our results, systemic reviews and recent randomized trials for RARC have shown that oncological outcomes of MIRC are equivalent to those of ORC . Similar to previous reports, 5‐year relapse‐free survival, cancer‐specific survival and overall survival were stratified into pT and pN, and the presence or absence of lymph node dissection, pT and pN were significant factors associated with recurrence on multivariate analysis.…”

“…[11][12][13] In accordance with our results, systemic reviews and recent randomized trials for RARC have shown that oncological outcomes of MIRC are equivalent to those of ORC. 3,4,[14][15][16] Similar to previous reports, 5-year relapse-free survival, cancer-specific survival and overall survival were stratified into pT and pN, and the presence or absence of lymph node dissection, pT and pN were significant factors associated with recurrence on multivariate analysis. Whether MIRC increases port-site recurrence or disseminated abdominal recurrence, such as carcinomatous peritonitis, is highly controversial.…”

Editorial Comment to Current status and future perspective of robot‐assisted radical cystectomy for invasive bladder cancer

“…Fujimura reviewed robot‐assisted radical cystectomy (RARC) for bladder cancer . In this study, the author comprehensively described many issues, including the worldwide spread of RARC, patient selection, preoperative management, surgical procedures, lymph node dissection, urinary diversion (UD), complications, oncological outcomes, patterns of recurrence, educational programs, cost and future perspectives.…”

“…Although RARC is becoming widespread, there are many points that should be discussed, as described by Fujimura . Of these, the choice of the procedure for UD, extracorporeal or intracorporeal (ICUD), is an important point in RARC.…”

“…It is reasonable that extracorporeal UD should be chosen in initial cases of RARC, and that ICUD should be introduced after mastery through a learning curve. Fujimura also described a step‐by‐step educational program with procedural checkpoints and time limits for robot‐assisted radical prostatectomy and robot‐assisted partial nephrectomy . Because RARC with UD consist of many steps that take a relatively long time regardless of extracorporeal UD or ICUD, how to learn them is an important theme.…”