Randomized Trial Comparing Open Radical Cystectomy and Robot-assisted Laparoscopic Radical Cystectomy: Oncologic Outcomes

Abstract

Of 118 patients randomly assigned to undergo radical cystectomy/pelvic lymphadenectomy and urinary diversion, half were assigned to open surgery and half to robot-assisted techniques. We found no difference in risk of recurring or dying of bladder cancer between the two groups.

Utility of robot‐assisted radical cystectomy with intracorporeal urinary diversion for muscle‐invasive bladder cancer

“…Likewise, Bochner et al . reported that there were no significant differences in DFS or OS between ORC and RARC . However, in that randomized study, it appeared that the patient population was skewed toward earlier stage disease given the percentage of patients with organ‐confined disease .…”

“…In a recent prospective randomized trial comparing RARC with ORC, there were no statistically significant differences between the groups, even though the ORC group tended toward higher overall rates of distant recurrence as their first site of recurrence than the RARC group (27.6% and 16.7%, respectively; P = 0.077) . However, the ORC group showed significantly less local/regional recurrence than the RARC group (10.3% and 16.7%, respectively; P = 0.035) …”

“…However, in that randomized study, it appeared that the patient population was skewed toward earlier stage disease given the percentage of patients with organ‐confined disease . In retrospective RARC series or prospective series without adequate controls, patient selection introduces bias, which makes it difficult to directly compare oncological outcomes between two surgical techniques …”

“…ORC is associated with high morbidity, with historical rates of postoperative complications between 30% and 60% in large pelvic oncology centers . Minimally invasive surgical techniques have been widely used in a variety of surgical procedures . LRC might proffer benefits in terms of EBL, analgesic requirements and reduced scarring .…”

“…However, ICUD might have potential benefits, including decreased fluid loss, reduced EBL and a quicker return of bowel function . The adoption of ICNB has hitherto been limited to high‐volume academic institutions, and several surgical techniques for ICNB have been reported with promising functional outcomes …”