Differences in utilization-trend and time changes of peri-operative outcomes of robotic and open radical cystectomy between American and European selected centers: an international multicenter collaboration.

To compare utilization trends and time-changes in perioperative outcomes of robot assisted radical cystectomy (RARC) in American (AC) and European centers (EC).

retrospective evaluation of 2,401 patients treated with open radical cystectomy (ORC) and RARC for bladder cancer at 12 AC and EC between 2006 and 2018. Kruskal-Wallis and Chi-square test evaluated differences between continuous and categorical variables.

Overall, 49.5% of patients underwent RARC and 51.5% ORC. RARC became the most commonly performed procedure in contemporary patients with an increase from 29% in 2006-2008 to 54% in 2015-2018 (p<0.001). In AC, the use of RARC was higher than ORC since 2006 and remained stable over time whereas in EC its use increased exponentially from 2% to 50%. In both groups RARC patients had less advanced T stages (p<0.001), ASA scores (p<0.05), lower blood loss (p=0.001) and shorter length of stay (p<0.05). No differences were found in early complications. Early readmissions- and reoperations-rates were worse for patients treated with RARC in EC. However, when contemporary patients only were considered, the statistical significances were lost.

Our study reveals that the use of RARC has constantly increased since its introduction, overtaking ORC in the most contemporary series. While RARC was more frequently performed than ORC since the beginning in AC and remained substantially stable over time, its use exponentially increased in the EC. The different trend in use and time-changes of peri-operative outcome between AC and EC can be attributed to the earlier introduction and spread of RARC in AC compared to the European ones. This article is protected by copyright. All rights reserved.

BJU international. 2019 May 04 [Epub ahead of print]

Stefania Zamboni, Francesco Soria, Romain Mathieu, Evanguelos Xylinas, Mohammad Abufaraj, David D'Andrea, Wei Shen Tan, John D Kelly, Giuseppe Simone, Michele Gallucci, Anoop Meraney, Suprita Krishna, Badrinath R Konety, Alessandro Antonelli, Claudio Simeone, Philipp Baumeister, Agostino Mattei, Alberto Briganti, Andrea Gallina, Francesco Montorsi, Michael Rink, Atiqullah Aziz, Pierre I Karakiewicz, Morgan Rouprêt, Anthony Koupparis, Douglas S Scherr, Guillaume Ploussard, Prasanna Sooriakumaran, Shahrokh F Shariat, Marco Moschini, European Association of Urology - Young Academic Urologists (EAU-YAU) Urothelial carcinoma working group , EAU Research Foundation

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