Open Versus Robotic Radical Cystectomy With Intracorporeal Neobladder: A Decade-Long Single-Surgeon Experience.

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Bladder cancer treatment often involves radical cystectomy.
• Open radical cystectomy (ORC) and robot-assisted radical cystectomy (RARC) are surgical options.
• Comparison of ORC and RARC with intracorporeal neobladder (RIN) is crucial for patient outcomes.

Purpose of the Study:

• To evaluate open radical cystectomy (ORC) versus robot-assisted radical cystectomy (RARC) with intracorporeal neobladder (RIN).
• To compare perioperative, oncological, and functional outcomes in bladder cancer patients.
• To assess long-term survival and continence rates.

Main Methods:

• Single-center, single-surgeon study of 454 patients (2009-2020).
• Comparison of open radical cystectomy (ORC) and robot-assisted intracorporeal neobladder (RIN).
• Data collection included perioperative variables, cancer-specific survival (CSS), overall survival (OS), and functional outcomes.

Main Results:

• Robot-assisted intracorporeal neobladder (RIN) showed significantly less blood loss, higher lymph node yield, and fewer 30-day readmissions.
• Complication rates were similar between open radical cystectomy (ORC) and RIN groups.
• RIN demonstrated improved severe daytime continence; 10-year CSS favored RARC in T3 disease (68.3% vs. 50.5%).

Conclusions:

• Robot-assisted intracorporeal neobladder (RIN) offers advantages in blood loss, lymph node yield, readmissions, and daytime continence over open radical cystectomy (ORC).
• Long-term oncological outcomes, including overall survival, were comparable, with a trend favoring RARC in T3 disease.
• RARC with RIN represents a viable and potentially superior alternative for select bladder cancer patients.