Robotic versus Open Radical Cystectomy: An Updated Systematic Review and Meta-Analysis

Abstract

ObjectiveTo critically review the currently available evidence of studies comparing robot-assisted radical cystectomy (RARC) with open radical cystectomy (ORC).MethodsA comprehensive review of the literature from Pubmed, Web of Science and Scopus was performed in April 2014. All relevant studies comparing RARC with ORC were included for further screening. A pooled meta-analysis of all comparative studies was performed and publication bias was assessed by a funnel plot.ResultsNineteen studies were included for the analysis, including a total of 1779 patients (787 patients in the RARC group and 992 patients in the ORC group). Although RARC was associated with longer operative time (p <0.0001), patients in this group might benefit from significantly lower overall perioperative complication rates within 30 days and 90 days (p = 0.005 and 0.0002, respectively), more lymph node yields (p = 0.009), less estimated blood loss (p <0.00001), lower need for perioperative and intraoperative transfusions (p <0.0001 and <0.0001, respectively), and shorter postoperative length of stay (p = 0.0002). There was no difference between two groups regarding positive surgical margin rates (p = 0.19).ConclusionsRARC appears to be an efficient alternative to ORC with advantages of less perioperative complications, more lymph node yields, less estimated blood loss, lower need for transfusions, and shorter postoperative length of stay. Further studies should be performed to compare the long-term oncologic outcomes between RARC and ORC.

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

“…In our series, patients undergoing RARC and intra-corporeal urinary diversion experienced a mean overall blood loss of 534 ± 153.2 ml. This finding is comparable to other previously reported prospective, randomized and retrospective studies [5,15,16], with median blood loss ranging 208-1,118 ml, depending on the type (ileal conduit, neobladder) and surgical approach adopted (ex-tracorporeal, intracorporeal) for urinary diversion [17]. It is important to underline the low need for intra-operative transfusions (5.9%) in our series, which is remarkably lower if compared to other RARC series, ranging 7-44% [17].…”

“…Furthermore, the rate of intraoperative transfusions was found to be lower in the RARC group (5.9 vs. 24.2%). These findings are not surprising, since many reports and systematic reviews of cumulative or randomized studies confirmed the advantage of robotic approach in decreasing the blood loss and transfusions rate when compared to open technique [5,7,15,16,18,19]. …”

“…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. Interestingly, 2 recent randomized trials with a larger cohort of patients [15,16] and 2 systematic review and meta-analyses [5,17] reported comparable blood loss and transfusions rates. In our series, patients undergoing RARC and intra-corporeal urinary diversion experienced a mean overall blood loss of 534 ± 153.2 ml.…”

“…Currently, open radical cystectomy (ORC) is still the gold standard approach, but a significant morbidity, high complication rate and mortality is still related to this technique [2,3,4]. More recently, robot-assisted radical cystectomy (RARC) has emerged as an attractive alternative to ORC, aiming to reduce morbidity and complications, and to potentially improve peri-operative and functional outcomes [5,6,7,8]. …”

Robotic Assisted Radical Cystectomy with Extracorporeal Urinary Diversion Does Not Show a Benefit over Open Radical Cystectomy: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

“…Previously, there have been four other systematic reviews on this topic, however these included both retrospective and prospective comparative studies which were at high risk of selection, reporting and publication bias [7, 8, 10, 20]. These meta-analyses have concluded that RARC is associated with lower perioperative complications, reduced LOS, higher lymph node yield, lower transfusion requirement and equivocal PSM.…”