Survival Outcomes of Open Versus Robot-Assisted Radical Cystectomy: A Large-Scale Multicenter Propensity Score...

Area of Science:

• Urology
• Surgical Oncology
• Robotic Surgery

Background:

• Robot-assisted radical cystectomy (RARC) adoption is increasing, but long-term survival comparisons with open radical cystectomy (ORC) are limited.
• Uncertainty exists regarding the oncological outcomes and survival benefits of RARC versus ORC.

Purpose of the Study:

• To compare long-term survival outcomes between RARC and ORC.
• To evaluate the oncological safety and efficacy of RARC in a large, propensity score-matched cohort.

Main Methods:

• Retrospective analysis of 3972 radical cystectomy patients from 11 Korean centers (2003-2024).
• 1:1 propensity score matching (PSM) applied to mitigate baseline differences between ORC and RARC groups.
• Kaplan-Meier analysis and multivariable Cox regression used to assess overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS).

Main Results:

• PSM created 473 well-matched pairs. RARC showed longer operative times but superior perioperative outcomes (less blood loss, fewer transfusions, shorter hospital stays, higher lymph node yield, lower positive margin rates).
• RARC significantly improved 5- and 10-year OS (75.4% vs 56.1%; 68.3% vs 44.5%) and CSS (88.1% vs 71.6%; 82.7% vs 67.7%) (p < 0.001).
• Recurrence-free survival (RFS) was comparable between RARC and ORC (p = 0.155). RARC was an independent predictor of improved OS and CSS (HR < 0.6, p < 0.001).

Conclusions:

• RARC offers superior perioperative outcomes and favorable survival trends compared to ORC.
• RARC appears oncologically safe, demonstrating improved overall and cancer-specific survival without compromising recurrence-free survival.
• Exploratory survival benefits require cautious interpretation due to potential residual confounding; prospective validation is recommended.