Pure open versus robotic radical cystectomy with intracorporeal urinary diversion: a propensity matched analysis

To compare surgical parameters and short-term outcomes between open radical cystectomy (ORC) and robotic radical cystectomy with total intracorporeal urinary diversion (icRARC).

Among the study period, 133 patients who underwent ORC and pelvic node dissection for bladder cancer (group 1) were matched and compared to 61 patients who underwent icRARC during the same period (group 2). The groups were matched 1:1 according to their propensity scores adjusted on their baseline demographics and disease characteristics. The main surgical parameters compared were: operative time, estimated blood loss (EBL), and postoperative outcomes including time to oral intake, ninety-day complications, readmission rate, and secondary procedures.

Overall, 122 patients (61 in each group) were matched and finally analyzed. Although operative times (307 ± 97 min vs. 444 ± 113 min; p < 0.001) were longer, EBL (948 ± 657 ml vs. 357 ± 219 ml; p < 0.001) and transfusion rates were lower in the icRARC group. Overall complications were comparable but late complications tended to be lower in the icRARC group (p = 0.06). Readmission rate (54.8% vs. 26.8%, p = 0.01) was higher in the ORC group while secondary procedures (28.6% vs. 12.5%, p = 0.07) also tended to be lower in the robotic approach. Finally, in multivariable logistic regression the icRARC group was not associated with any complications of any grade including grade 3 or higher compared to the open approach.

This study comparing open radical cystectomy to robotic radical cystectomy with total intracorporeal urinary diversion demonstrated encouraging outcomes for the minimally invasive management of urothelial carcinoma.