Open Versus Robotic Cystectomy: A Propensity Score Matched Analysis Comparing Survival Outcomes

Area of Science:

• Urology
• Surgical Oncology

Background:

• Robotic assisted radical cystectomy (RARC) and open radical cystectomy (ORC) are surgical options for bladder cancer.
• Comparative survival outcomes between RARC and ORC require further investigation in large cohorts.

Purpose of the Study:

• To compare the differential effect of RARC versus ORC on survival outcomes.
• To analyze recurrence and cancer-specific mortality (CSM) in a matched multicentric cohort.

Main Methods:

• A large multicentric cohort of 9757 patients with urothelial bladder cancer undergoing radical cystectomy.
• Propensity score matching (2:1) to create a balanced cohort of 1374 patients.
• Multivariable competing risk analyses to assess the association of surgical technique with recurrence and CSM.

Main Results:

• RARC and ORC demonstrated similar 3-year recurrence rates and CSM in the overall and propensity-matched populations.
• Multivariable analyses confirmed no significant difference in recurrence or CSM between RARC and ORC (p > 0.1).
• Median follow-up was 81 months pre-matching and 102 months post-matching.

Conclusions:

• Robotic assisted radical cystectomy and open radical cystectomy yield comparable survival outcomes for bladder cancer patients.
• Current data supports that surgical approach does not significantly impact long-term survival.
• This information is valuable for patient counseling pending level one evidence.