Systematic Review and Cumulative Analysis of Oncologic and Functional Outcomes After Robot-assisted Radical Cystectomy

Abstract

Context: Although open radical cystectomy (ORC) is still the standard approach, laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) are increasingly performed.Objective: To report on a systematic literature review and cumulative analysis of pathologic, oncologic, and functional outcomes of RARC in comparison with ORC and LRC.Evidence acquisition: Medline, Scopus, and Web of Science databases were searched using a free-text protocol including the terms robot-assisted radical cystectomy or da Vinci radical cystectomy or robot* radical cystectomy. RARC case series and studies comparing RARC with either ORC or LRC were collected. A cumulative analysis was conducted.Evidence synthesis: The searches retrieved 105 papers, 87 of which reported on pathologic, oncologic, or functional outcomes. Most series were retrospective and had small case numbers, short follow-up, and potential patient selection bias. The lymph node yield during lymph node dissection was 19 (range: 3-55), with half of the series following an extended template (yield range: 11-55). The lymph node-positive rate was 22%. The performance of lymphadenectomy was correlated with surgeon and institutional volume. Cumulative analyses showed no significant difference in lymph node yield between RARC and ORC. Positive surgical margin (PSM) rates were 5.6% (1-1.5% in pT2 disease and 0-31% in pT3 and higher disease). PSM rates did not appear to decrease with sequential case numbers. Cumulative analyses showed no significant difference in rates of surgical margins between RARC and ORC or RARC and LRC.Neoadjuvant chemotherapy use ranged from 0% to 31%, with adjuvant chemotherapy used in 4-22% of patients. Only six series reported a mean follow-up of >36 mo. Three-year disease-free survival (DFS), cancer-specific survival (CSS), and overall survival (OS) rates were 53-74%, 68-83%, and 72-80%, respectively. The 5-yr DFS, CSS, and OS rates were 53-74%, 66-80%, and 39-66%, respectively. Similar to ORC, disease of higher pathologic stage or evidence of lymph node involvement was associated with worse survival. Very limited data were available with respect to functional outcomes. The 12-mo continence rates with continent diversion were 83-100% in men for daytime continence and 66-76% for nighttime continence. In one series, potency was recovered in 63% of patients who were evaluable at 12 mo. Conclusions

A Single-centre Early Phase Randomised Controlled Three-arm Trial of Open, Robotic, and Laparoscopic Radical Cystectomy (CORAL)

“…The rate for RARC seems high, especially considering the Pasadena Consensus Panel recommendation of <7% PSM rate for RARC [21]. However, we believe our findings reflect our practice of not routinely performing simultaneous urethrectomy unless there is tumour in the urethra because this increases morbidity.…”

The feasibility and effectiveness of robot-assisted radical cystectomy after neoadjuvant chemotherapy in patients with muscle-invasive bladder cancer

“…Disease-specific survival (DFS) was 79-96%, 67-76% and 53-74%, respectively (21). However, only 6/18 series (33%) reported a mean follow-up >36 months (21). On the other hand, Raza et al reported the long-term oncological outcomes using the IRCC database (11).…”

“…At 1, 3 and 5 years, OS was 82-90%, 61-80% and 39-66%, respectively. Disease-specific survival (DFS) was 79-96%, 67-76% and 53-74%, respectively (21). However, only 6/18 series (33%) reported a mean follow-up >36 months (21).…”

“…In recent years, several authors have described the feasibility of robotic approaches in patients undergoing RC for BC (8-10). Yuh et al performed a systematic review and cumulative analysis of oncological and functional outcomes of RARC (21). At 1, 3 and 5 years, OS was 82-90%, 61-80% and 39-66%, respectively.…”

Feasibility of expert and crowd-sourced review of intraoperative video for quality improvement of intracorporeal urinary diversion during robotic radical cystectomy

“…Retrospective video review has been used in open 9 and laparoscopic radical prostatectomy 10 to identify surgical steps correlated with potency and technical errors leading to positive surgical margin, respectively. Robot-assisted radical cystectomy (RARC) is becoming increasingly used and is under close scrutiny with regards to complications, [11][12][13] such as strictures at the uretero-ileal anastomosis. These may require further endoscopic or surgical intervention and represent a potentially preventable complication of RARC.…”