Robotic Versus Open Radical Cystectomy: Prospective Comparison of Perioperative and Pathologic Outcomes in Japan

Abstract

Objective: In Japan, no study has compared the perioperative outcomes observed between robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC). This study aimed at a prospective comparison of the perioperative outcomes between RARC and ORC performed by a single surgeon. Methods: Between 2008 and 2011, 26 bladder cancer patients underwent radical cystectomy by one surgeon, 11 robotically and 15 by open procedure. We prospectively collected perioperative and pathological data for these 26 patients, and retrospectively compared these two different surgical procedures. Results: The RARC cohort had a significant decrease in both estimated blood loss (656.9 vs. 1788.7 ml, P ¼ 0.0015) and allogeneic transfusion requirement (0 vs. 40%, P ¼ 0.0237). The total operative time was almost the same (P ¼ 0.2306) but increased duration of bladder removal and lymphadenectomy was observed in the RARC cohort (P ¼ 0.0049). Surgeryrelated complication rates within 30 days were not significantly different (P ¼ 0.4185). Positive surgical margin was observed in three patients in the ORC cohort and in one patient in the RARC cohort (P ¼ 0.4664). The RARC cohort had a larger number of removed lymph nodes than the ORC cohort, and the difference was statistically significant (20.7 vs. 13.8, P ¼ 0.0421). Conclusions: We confirmed that RARC is safe and yields acceptable outcomes in comparison with ORC for the treatment of bladder cancer if it is performed by a surgeon who has experience of over 60 cases of robot-assisted radical prostatectomy. It is hoped that RARC will gain acceptance in Japan as a minimally invasive surgery for muscle-invasive bladder cancer.

Peri-Operative Outcomes after Open and Robot-Assisted Radical Cystectomy by Using an Advanced Bipolar Seal and Cut Technology (Caiman®): A Prospective, Comparative, and Multi-Institutional Study

“…When compared to the previously published studies, however, our series shows a quite low occurrence of 30-and 90-day adverse events. Cusano et al [8] reported a 30-day incidence of complication in 54.3 and 47.1% of patients treated with ORC and RARC, respectively (p = 0.33); similarly, Gondo et al [14] showed adverse events after 30 days in 54.5% of ORC and 73.3% of RARC (p = 0.41). A quite higher occurrence of post-operative complications was reported in the 2 recent randomized trials as well.…”

“…The mean blood loss was 986 ml, with a 47% of patients requiring transfusions. Gondo et al [14] in their single-institutional report of 15 ORC and 11 RARC performed by the same surgeon, reported a median blood loss of 1,788 ml in patients treated with ORC, and 40% of patients required intraoperative blood transfusions. If compared to these data, in our series we observed a quite lower mean blood loss (777 ml) and transfusions rate (24%) in ORC patients.…”

“…The most complex surgical steps during RARC, especially considering the reconstructive phases (intracorporeal urinary diversion, ileal neoblad-der), actually represent the most important factors responsible for a longer operative time. Only few studies reported similar operative time between the 2 techniques [14,19]. Notably, in the randomized trial by Parekh et al [19], no surgical details were offered in terms of urinary diversion choice or approach (extracorporeal/intracor-poreal); conversely, Gondo et al [14] performed all the urinary diversion after RARC by an extracorporeal approach, thus offering a possible explanation for an overlapping operative time between the 2 techniques.…”

Is the open cystectomy era over? An update on the available evidence

“…The accumulating oncological outcome data for RARC is supported by encouraging short‐term and intermediate outcome reports. Table summarizes data from large ORC and RARC series, as well as head‐to‐head series, including the four RCTs and the recent RCT meta‐analysis …”

Does minimally invasive surgery for radical cystectomy provide similar long-term cancer control as open radical surgery?

“…Another recent small series [30] compared the perioperative outcomes in 11 and 15 patients who underwent RARC and ORC, respectively, by a single surgeon. This series also demonstrated the selection bias toward earlier stage disease in RARC.…”