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Comparing Open Radical Cystectomy and Robot-assisted Laparoscopic Radical Cystectomy: A Randomized Clinical Trial.

Bernard H Bochner1, Guido Dalbagni1, Daniel D Sjoberg2

  • 1Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.

European Urology
|December 16, 2014
PubMed
Summary

Robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC) show similar 90-day complication rates for bladder cancer patients. This study found no significant advantage for robotic techniques over open surgery in this patient group.

Keywords:
Bladder cancerComplicationsCystectomyLymph node dissectionQuality of lifeRandomized controlled trialRobot assistedRoboticUrinary diversion

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Area of Science:

  • Urology
  • Surgical Oncology
  • Minimally Invasive Surgery

Background:

  • Open radical cystectomy (ORC) for bladder cancer carries a significant risk of perioperative complications.
  • Robot-assisted radical cystectomy (RARC) is an alternative surgical approach.
  • Comparing complication rates between ORC and RARC is crucial for patient management.

Purpose of the Study:

  • To compare perioperative complications between robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC).
  • To evaluate secondary outcomes including blood loss, operative time, quality of life, and costs.

Main Methods:

  • A prospective randomized controlled trial compared ORC/pelvic lymph node dissection (PLND) with RARC/PLND in 118 bladder cancer patients.
  • All urinary diversions were performed openly.
  • Patients were followed for 90 days, with complications graded using the modified Clavien system.

Main Results:

  • No significant difference in 90-day grade 2-5 complications between RARC (62%) and ORC (66%) groups (p=0.7).
  • RARC showed lower blood loss (p=0.027) but longer operative time (p<0.001).
  • Pathologic outcomes, hospital stay, and 3- and 6-month quality-of-life outcomes were similar; ORC was more cost-effective.

Conclusions:

  • Robot-assisted radical cystectomy does not offer a significant advantage over open radical cystectomy regarding 90-day complications.
  • Surgical technique did not impact hospital stay, pathologic outcomes, or quality of life.
  • Open radical cystectomy demonstrated better cost-effectiveness compared to RARC.