Open Versus Robotic Radical Cystectomy With Intracorporeal Studer Diversion

Abstract

Background and Objectives:To compare open versus totally intracorporeal robotic-assisted radical cystectomy, bilateral extended pelvic lymph node dissection, and Studer urinary diversion in bladder cancer patients.Methods:A retrospective comparison of open (n = 42) versus totally intracorporeal (n = 32) robotic-assisted radical cystectomy, bilateral extended pelvic lymph node dissection, and Studer urinary diversion was performed concerning patient demographic data, operative and postoperative parameters, pathologic parameters, complications, and functional outcomes.Results:Patient demographic data and the percentages of patients with pT2 disease or lower and pT3–pT4 disease were similar between groups (P > .05). Positive surgical margin rates were similar between the open (n = 1, 2.4%) and robotic (n = 2, 6.3%) groups (P > .05). Minor and major complication rates were similar between groups (P > .05). Mean estimated blood loss was significantly lower in the robotic group (412.5 ± 208.3 mL vs 1314.3 ± 987.1 mL, P < .001). Significantly higher percentages of patients were detected in the robotic group regarding bilateral neurovascular bundle–sparing surgery (93.7% vs 64.3%, P = .004) and bilateral extended pelvic lymph node dissection (100% vs 71.4%, P = .001). The mean lymph node yield was significantly higher in the robotic group (25.4 ± 9.7 vs 17.2 ± 13.5, P = .005). The number of postoperative readmissions for minor complications was significantly lower in the robotic group (0 vs 7, P = .017). Better trends were detected in the robotic group concerning daytime continence with no pad use (84.6% vs 75%, P > .05) and severe daytime incontinence (8.3% vs 16.6%, P > .05). No significant differences were detected regarding postoperative mean International Index of Erectile Function scores between groups (P > .05).Conclusions:Robotic surgery has the advantages of decreased blood loss, better preservation of neurovascular bundles, an increased lymph node yield, a decreased rate of hospital readmissions for minor complications, and a better trend for improved daytime continence when compared with the open approach.

A cost-effectiveness modeling study of robot-assisted (RARC) versus open radical cystectomy (ORC) for bladder cancer to inform future research

“…Eight studies [15][16][17][18][19][20][21][22] and another nine studies [7,18,20,[23][24][25][26][27][28] provided data for our 30d and 90d model, respectively. Probabilities of complications were assessed by calculating the weighted average of these studies (Table 1 and Supplement 4).…”

Robotic radical cystectomy for the management of bladder cancer: Analysis of operative and pathological outcomes of eighteen patient

“…[25] In the United States of America NAC was used in 20.9% of the cases in the year 2010, while it has been used in 12-29%+ of the patients. [12,24,26] Since most of our patients had local disease, NAC was used in 11% of our patients. However our use of NAC will increase in line with increase in the number of our patients with locally advanced disease.…”

“…[10,11] Though in recent years robotic surgery has been widely used in Turkey, only a few studies on RRC have been published so far. Atmaca et al [12] compared RRC, and open cystectomy series, and indicated improved oncological, and functional outcomes in robotic surgery. They also demonstrated superiority of RRC in terms of lymph node dissection, blood loss, and duration of hospitalization.…”

Functional Outcomes After Robotic Radical Cystectomy with Intracorporeal Diversion: A Systematic Review

“…Sexual outcomes are influenced in part by the level of nerve preservation during the surgery, which also depends on the disease burden determined by preoperative and intraoperative evaluation. While there have been concerns of local recurrence with nerve sparing, several studies have demonstrated the safety of performing a nerve sparing procedure with low rates of recurrence [9,11], A continued challenge of assessing functional outcomes still exists due to the small number of patients recruited in these studies and the largely retrospective nature of the analyses, which makes it difficult to ascertain differences between the varying techniques.…”

“…For example, Kulkarni et al defined daytime continence as no incontinence (0-1 pad/day), mild (1-2 pads/day), moderate (3 pads/day), and severe (>3 pads/day). Nocturnal continence specifically was defined as good (dry with no protection), fair (dry with 1 awakening), or poor (wet, leakage, and incontinence during sleep) [11]. Some reports regarding functional outcomes in patients after RARC with ICUD have been published.…”