SIU 2017: Open vs. Robot assisted Radical Cystectomy: Robot is useless

Lisbon, Portugal ( Dr. Rawal began his presentation by stating that there is sufficient data on oncological adequacy of Robotic assisted Radical Cystectomy (RARC) both in randomized and non- randomized trials. Although RARC  has been in use for quite some time (since 2003), no meta-analysis has been able to show the superiority of RARC over open radical cystectomy (ORC) in terms of clinical outcomes such as complications and health related quality of life. One of the reasons for this is the fact that this is a very technically difficult procedure. RARC has a learning curve of at least 30 cases for experienced pelvic robotic surgeons. Complete intra-corporeal urinary diversion has an even longer learning curve, necessitating up to 45 cases for experienced robotic surgeons.
Dr. Rawal mentions additional concerns with the rising trend of utilization of RARC. There has been genuine concerns that by using RARC, surgeons tend to favor ileal conduits (IC) over neobladders. Furthermore, true principles of open surgery while constructing neobladders, may have not been followed. Lastly, in low volume centers, RARC results are even worse.

The medical literature thus far has shown that RARC is a significantly longer procedure with no advantage in the rate of complication, hospital length of stay, or health related quality of life. Furthermore, cost analysis has demonstrated that RARC is significantly more expensive than ORC, especially when a neobladder is created. There is also some evidence to show that the stricture rate of the uretero-intestinal anastomosis is higher with RARC than with ORC.

Dr. Rawal concluded his presentation by stating that RARC is still a technique in evolution and needs to mature, especially when creating a neobladder. Thus far, no high quality evidence has proven its superiority over ORC in terms of complication rate and health related quality of life.

Speaker: Sudhir Kumar Rawal

Written by: Hanan Goldberg, MD, Urologic Oncology Fellow (SUO), University of Toronto, Princess Margaret Cancer Centre.Twitter: @GoldbergHanan at the 37th Congress of Société Internationale d’Urologie - October 19-22, 2017- Lisbon, Portugal

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