Intra-corporeal robot-assisted versus open radical cystectomy: a meta-analysis

To compare the safety and effectiveness between robot-assisted radical cystectomy with intracorporeal urinary diversion (iRARC) and open radical cystectomy (ORC).

We conducted this systematic review and meta-analysis of the primary outcomes of interest according to the PRISMA and AMSTAR Guidelines. Five databases were systematically searched, including Medline, PubMed, Cochrane Library, Scopus, and Web of Science. The search timeframe was set from database creation to February 2026.

There were 30 studies including 8857 patients. Compared with ORC, iRARC was superior in terms of estimated blood loss [WMD=-523.18, 95% CI (-622.68, -423.68), P < 0.01], length of stay [WMD=-2.30, 95% CI (-3.27, -1.33), P < 0.01], lymph nodes removed [WMD = 2.39, 95% CI (0.16, 4.62), P < 0.05], transfusion [OR = 0.15, 95% CI (0.08, 0.29), P < 0.01], positive surgical margin [OR = 0.73, 95% CI (0.55, 0.96), P < 0.05], postoperative complications [OR = 0.59, 95% CI (0.37, 0.95), P < 0.05], Clavien-Dindo > II complications [OR = 0.66, 95% CI (0.47, 0.94), P < 0.05], and intraoperative complications [OR = 0.51, 95% CI (0.26, 0.97), P < 0.05], but it had a longer operative time [WMD = 66.11, 95% CI (45.31, 86.90), P < 0.01]. The two surgical groups were comparable in terms of solid food intake time (p = 0.29), bowel obstruction (p = 0.36), and Clavien-Dindo I-II complications (p = 0.34). Postoperative long-term follow-up results showed that iRARC was superior in terms of 30-day complications [OR = 0.58, 95% CI (0.38, 0.88), P < 0.05], 90-day complications [OR = 0.67, 95% CI (0.58, 0.78), P < 0.01], 30-day Clavien-Dindo > II complications [OR = 0.66, 95% CI (0.52, 0.84), P < 0.05], 90-day Clavien-Dindo > II complications [OR = 0.77, 95% CI (0.63, 0.94), P < 0.01], 5-year cancer-specific survival [CSS HR = 0.71, 95% CI (0.51, 0.98), P < 0.05], and 5-year overall survival [OS HR = 0.73, 95% CI (0.60, 0.87), P < 0.01], but it had a higher incidence of ureteroenteric stricture [UES OR = 1.57, 95% CI (1.18, 2.09), P < 0.01]. The two surgical groups were comparable in terms of 30-day Clavien-Dindo I-II complications (p = 0.28), 90-day Clavien-Dindo I-II complications (p = 0.99), 30-day readmission (p = 0.68), 90-day readmission (p = 0.51), 90-day death (p = 0.37), recurrence (p = 0.18), 3-year CSS (p = 0.88), and 3-year OS (p = 0.19).

Compared with ORC, iRARC was associated with improved perioperative outcomes, but attention should be paid to the monitoring and management of postoperative UES. Although improved 5-year OS and CSS were observed, these findings should be interpreted with caution because most of the available evidence was derived from observational studies and may have been influenced by residual confounding. Further large-scale, high-quality randomized controlled trials are needed to validate these findings.