A systematic review and meta-analysis comparing the outcomes of open and robotic assisted radical cystectomy

Robotic assisted radical cystectomy (RARC) is gaining popularity worldwide, although its enthusiastic implementation is supported mainly by retrospective studies. Aim of this review is to compare the outcomes of RARC and open radical cystectomy (ORC) in the setting of randomized controlled trials (RCTs).

Three search engines (PubMed, Embase®, and Web of Science) were queried up to January 1, 2019. Studies selections followed The Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) Statement to find studies regarding patients with clinically localized muscle invasive and high risk non muscle invasive bladder cancer who underwent RARC or ORC to evaluate surgical, pathological, and oncological outcomes. The statistical analysis was performed with RevMan 5.3.

Five randomized controlled trial were identified. We found RARC group to be not associated to neoadjuvant chemotherapy (OR: 0.67; 95%CI: 0.46, 0.98; P=0.04). ORC had shorter operative time (OT) (WMD: 95.14 minutes; 95%CI: 50.59, 139.68; P<0.0001), whereas RARC showed to provide lower estimated blood loss (EBL) (WMD: -277.60 mL; 95%CI: -471.02, -84.18; P=0.005). RARC demonstrated lower risk of transfusions compared to the ORN group (OR: 0.52; 95%CI: 0.32, 0.85; P=0.008) as well as shorter LOS (WMD: -0.92 days; 95%CI: -1.46, -0.37; P=0.001). No difference was recorded in terms of pathological and oncological outcomes.

RARC does exhibit known benefits of minimally invasive surgery, although the impact of an enhanced recovery pathway is probably more important than the surgical approach in determining post-operative morbidity. To date, well designed prospective studies have found that RARC yields non-inferior oncologic outcomes compared to ORC.