Robot-assisted radical cystectomy (RARC) is increasingly being used to treat muscle-invasive bladder cancer in an attempt to improve functional outcomes and complication rates over open radical cystectomy (ORC). We performed a meta-analysis of randomized controlled trials (RCTs) to compare patient outcomes between RARC and ORC. The primary outcome measure was a composite of recurrence-free survival (RFS) or progression-free survival (PFS). As a secondary measure, we examined other surrogate oncologic endpoints, perioperative outcomes, and complications. We found no difference between RARC and ORC with respect to RFS/PFS (hazard ratio 0.89, 95% confidence interval 0.64-1.24), surgical margin rates, or lymph node dissection yield. Analysis of patterns of recurrence for (pelvic) versus distant/abdominal sites indicated a significant difference between RARC and ORC (p=0.04). This analysis represents a combination of post hoc analyses using RCT data and inconsistent between-study definitions of recurrence sites, and must be interpreted with caution. Lastly, RARC was associated with an advantage in estimated blood loss, but a longer operative time, with no difference in hospital length of stay or complication rates. These data support the oncologic safety of RARC; however, further research is required to assess potential differences in recurrence patterns. PATIENT SUMMARY: We synthesized data from recent randomized controlled trials to examine differences in cancer control between minimally invasive, robot-assisted radical cystectomy and traditional, open radical cystectomy. Our study shows that cancer control outcomes are comparable between robotic and open techniques, supporting the safety of minimally invasive surgery. Blood loss was lower in robotic surgery, but the robotic procedure was longer and did not have lower complications rates after surgery.

European urology oncology. 2018 Nov 16 [Epub]

Raj Satkunasivam, Christopher T Tallman, Jennifer M Taylor, Brian J Miles, Zachary Klaassen, Christopher J D Wallis

Department of Urology, Houston Methodist Hospital, Houston, TX, USA; Center for Outcomes Research, Houston Methodist Hospital, Houston, TX, USA. Electronic address: ., Department of Urology, Houston Methodist Hospital, Houston, TX, USA., Department of Urology, Baylor College of Medicine and Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA., Division of Urology, Medical College of Georgia-Augusta University, Augusta, GA, USA., Division of Urology, Department of Surgery, University of Toronto, Toronto, Canada.