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Oncologic Equipoise Between Robotic and Open Radical Cystectomy.

Janet Baack Kukreja1,2, Roger Li1,3, Vikram M Narayan1

  • 1Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA.

Journal of Endourology
|February 23, 2021
PubMed
Summary
This summary is machine-generated.

Robotic-assisted radical cystectomy (RARC) and open radical cystectomy (ORC) demonstrate comparable oncologic outcomes in bladder cancer patients. This study found no significant differences in recurrence-free survival or overall survival between the two surgical approaches.

Keywords:
bladder cancercystectomyrobot-assisted laparoscopic surgery

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Area of Science:

  • Urology
  • Surgical Oncology
  • Oncology

Background:

  • Radical cystectomy (RC) is a standard treatment for muscle-invasive bladder cancer.
  • Robotic-assisted radical cystectomy (RARC) has emerged as an alternative to open radical cystectomy (ORC).
  • Comparative oncologic outcomes between RARC and ORC require further large-scale investigation.

Purpose of the Study:

  • To compare positive surgical margin rates between RARC and ORC.
  • To evaluate recurrence patterns and survival outcomes (recurrence-free survival [RFS] and overall survival [OS]) following RARC versus ORC.
  • To identify predictors of RFS and OS after radical cystectomy.

Main Methods:

  • Retrospective cohort study of 1885 patients undergoing RC for bladder cancer (2005-2017).
  • Patients were categorized into ORC and RARC groups based on surgeon and patient choice.
  • Propensity matching and multivariable analyses were employed to assess RFS and OS predictors.

Main Results:

  • No significant differences were observed in positive soft tissue surgical margins (ORC: 2.4%, RARC: 1.2%) or recurrence patterns between the two approaches.
  • Peritoneal carcinomatosis incidence was low and similar in both groups (ORC: 1.1%, RARC: 0.8%).
  • Factors associated with shorter RFS included younger age, neoadjuvant chemotherapy, higher pathologic stage, lymph node positivity, and positive surgical margins. RFS and OS did not differ significantly based on surgical approach (RARC vs. ORC).

Conclusions:

  • RARC is a safe oncologic procedure for bladder cancer, yielding similar recurrence and survival outcomes compared to ORC.
  • The choice between RARC and ORC can be guided by patient and surgeon preference without compromising oncologic control.
  • Continued utilization of RARC is supported by these findings, offering a viable alternative to open surgery.