Venous Thromboembolism After Radical Cystectomy: A Systematic Comparison of Open Versus Robotic Approaches...

Radical cystectomy carries a substantial risk for venous thromboembolism (VTE), significantly impacting postoperative morbidity and mortality. This systematic review examines thrombotic complications comparing open radical cystectomy (ORC) versus robot-assisted radical cystectomy (RARC). Following PRISMA 2020 guidelines, we searched PubMed/MEDLINE, EMBASE, Cochrane Library, SCOPUS, and Web of Science from January 2003 through September 2025. Inclusion required complete reporting of deep vein thrombosis (DVT) or VTE rates, surgical approach specification, adult patients, minimum 30-day follow-up, and peer-reviewed publication. Studies with any missing outcome data were excluded. From 3,766 identified records, 31 studies met all criteria, encompassing 12,847 patients. DVT rates ranged from 3.2-11.5% after open surgery versus 0-5.6% following robotic approaches. Meta-analysis revealed significantly higher thrombotic risk with open surgery (OR: 1.65, 95% CI: 1.23-2.21, P=0.001). Key predictors included prior VTE (OR: 8.73), COPD (OR: 3.24), advanced stage (OR: 2.73), and obesity (OR: 1.94). Extended 28-day prophylaxis reduced VTE incidence by 58% compared to in-hospital prophylaxis alone. Direct oral anticoagulants showed noninferior efficacy to low-molecular-weight heparin. Robotic cystectomy demonstrates significantly lower thrombotic risk, though appropriate prophylaxis remains essential regardless of surgical approach.