Sathianathen, Niranjan J; Pan, Henry Y C; Furrer, Marc; Thomas, Benjamin; Dundee, Philip; Corcoran, Niall; Weight, Christopher J; Konety, Badrinath; Nair, Rajesh; Lawrentschuk, Nathan (2023). Comparison of Robotic vs Open Cystectomy: A Systematic Review. Bladder cancer, 9(3), pp. 253-269. IOS Press 10.3233/BLC-220065
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BACKGROUND
The benefits of a robot-assisted radical cystectomy (RARC) compared to an open approach is still under debate. Initial data on RARC were from trials where urinary diversion was performed by an extracorporeal approach, which does not represent a completely minimally invasive procedure. There are now updated data for RARC with intracorporeal urinary diversion that add to the evidence profile of RARC.
OBJECTIVE
To perform a systematic review and meta-analysis of the effectiveness of RARC compared with open radical cystectomy (ORC).
MATERIALS AND METHODS
Multiple databases were searched up to May 2022. We included randomised trials in which patients underwent RARC and ORC. Oncological and safety outcomes were assessed.
RESULTS
Seven trials of 907 participants were included. There were no differences seen in primary outcomes: disease progression [RR 0.98, 95% CI 0.78 to 1.23], major complications [RR 0.95, 95% CI 0.72 to 1.24] and quality of life [SMD 0.05, 95% CI -0.13 to 0.38]. RARC resulted in a decreased risk of perioperative blood transfusion [RR 0.57, 95% CI 0.43 to 0.76], wound complications [RR 0.34, 95% CI 0.21 to 0.55] and reduced length of hospital stay [MD -0.62 days, 95% CI -1.11 to -0.13]. However, there was an increased risk of developing a ureteric stricture [RR 4.21, 95% CI 1.07 to 16.53] in the RARC group and a prolonged operative time [MD 70.4 minutes, 95% CI 34.1 to 106.7]. The approach for urinary diversion did not impact outcomes.
CONCLUSION
RARC is an oncologically safe procedure compared to ORC and provides the benefits of a minimally invasive approach. There was an increased risk of developing a ureteric stricture in patients undergoing RARC that warrants further investigation. There was no difference in oncological outcomes between approaches.
Item Type: |
Journal Article (Review Article) |
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Division/Institute: |
04 Faculty of Medicine > Department of Dermatology, Urology, Rheumatology, Nephrology, Osteoporosis (DURN) > Clinic of Urology |
UniBE Contributor: |
Furrer, Marc |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
2352-3727 |
Publisher: |
IOS Press |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
15 Jul 2024 13:38 |
Last Modified: |
17 Jul 2024 12:57 |
Publisher DOI: |
10.3233/BLC-220065 |
PubMed ID: |
38993188 |
Uncontrolled Keywords: |
Bladder cancer complications cystectomy quality of life robotic surgical procedures |
BORIS DOI: |
10.48350/198974 |
URI: |
https://boris.unibe.ch/id/eprint/198974 |