The comparative effectiveness of robotic-assisted radical cystectomy (RARC) versus open radical cystectomy (ORC) in terms of perioperative outcomes is still a matter of debate affecting payors, physicians, and patients.
To evaluate comparative perioperative and longer-term morbidity of RARC versus ORC in a multicenter contemporary retrospective cohort of patients.
This retrospective multicenter study included patients with bladder cancer treated with radical cystectomy at 10 academic centers between 2000 and 2017.
Intraoperative outcomes including blood loss and operative time as well as postoperative outcomes including time to discharge, complication, readmission, reoperation, and mortality rates at 30 and 90 d were assessed. Multiple imputation and inverse probability of treatment weighting (IPTW) were used. IPTW-multivariable-adjusted regression and logistic analyses were performed to evaluate the associations of RARC versus ORC with perioperative outcomes at 30 and 90 d.
Overall, 1887 patients (1197 RARC and 690 ORC) were included in the study. After IPTW-adjusted analysis, no differences between the groups in terms of preoperative characteristics were observed. RARC was associated with lower blood loss (p<0.001), shorter length of stay (p<0.001), and longer operative time (p=0.007). On IPTW-adjusted multivariable logistic regression analyses, no differences in terms of 30- and 90-d complications, reoperation, and mortality rates were observed. RARC was independently associated with a higher readmission rate at both 30 and 90 d. Limitations are mainly related to the retrospective nature of the study.
While RARC was associated with less blood loss and shorter hospital stay, it also led to longer operation times and more readmissions. There were no differences in 30- and 90-d complications. Because there are no apparent differences in safety between ORC and RARC in expert centers, differences in oncologic and cost-effectiveness outcomes are likely to drive decision making regarding RARC utilization.
In this study we investigated the differences between RARC and ORC in terms of perioperative outcomes. We found no difference in early and late complications. We concluded that, to date, differences in oncologic and cost-effectiveness outcomes should drive decision making regarding RARC utilization.
European urology focus. 2018 Nov 16 [Epub ahead of print]
Francesco Soria, Marco Moschini, David D'andrea, Mohammad Abufaraj, Beat Foerster, Romain Mathiéu, Killian M Gust, Paolo Gontero, Giuseppe Simone, Anoop Meraney, Suprita Krishna, Badrinath Konety, Morgan Rouprêt, Matthew Perry, Edward Rowe, Guillaume Ploussard, Stephen A Boorjian, Peter Wiklund, Prasanna Sooriakumaran, Shahrokh F Shariat
Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, Milan, Italy; Department of Urology, Luzerner Kantonsspital, Luzern, Switzerland., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland., Department of Urology, Rennes University Hospital, Rennes, France., Division of Urology, Department of Surgical Sciences, San Giovanni Battista Hospital, University of Studies of Torino, Turin, Italy., "Regina Elena" National Cancer Institute, Department of Urology, Rome, Italy., Urology Division, Hartford Healthcare Medical Group, Hartford, CT, USA., Department of Urology, University of Minnesota, Minneapolis, MN, USA., Sorbonne Université, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France., Department of Urology, St George's Hospital, London, UK., Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol, UK., Department of Urology, Saint Jean Languedoc Hospital, Toulouse, France., Department of Urology, Mayo Clinic, Rochester, MN, USA., Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden., Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden; Department of Uro-oncology, University College London Hospital NHS Foundation Trust, London, UK., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York Presbyterian Hospital, New York, NY, USA; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: .