Open Versus Robotic Cystectomy: A Propensity Score Matched Analysis Comparing Survival Outcomes.

To assess the differential effect of robotic assisted radical cystectomy (RARC) versus open radical cystectomy (ORC) on survival outcomes in matched analyses performed on a large multicentric cohort.

The study included 9757 patients with urothelial bladder cancer (BCa) treated in a consecutive manner at each of 25 institutions. All patients underwent radical cystectomy with bilateral pelvic lymphadenectomy. To adjust for potential selection bias, propensity score matching 2:1 was performed with two ORC patients matched to one RARC patient. The propensity-matched cohort included 1374 patients. Multivariable competing risk analyses accounting for death of other causes, tested association of surgical technique with recurrence and cancer specific mortality (CSM), before and after propensity score matching.

Overall, 767 (7.8%) patients underwent RARC and 8990 (92.2%) ORC. The median follow-up before and after propensity matching was 81 and 102 months, respectively. In the overall population, the 3-year recurrence rates and CSM were 37% vs. 26% and 34% vs. 24% for ORC vs. RARC (all p values > 0.1), respectively. On multivariable Cox regression analyses, RARC and ORC had similar recurrence and CSM rates before and after matching (all p values > 0.1).

Patients treated with RARC and ORC have similar survival outcomes. This data is helpful in consulting patients until long term survival outcomes of level one evidence is available.

Journal of clinical medicine. 2019 Aug 09*** epublish ***

Marco Moschini, Stefania Zamboni, Francesco Soria, Romain Mathieu, Evanguelos Xylinas, Wei Shen Tan, John D Kelly, Giuseppe Simone, Anoop Meraney, Suprita Krishna, Badrinath Konety, Agostino Mattei, Philipp Baumeister, Livio Mordasini, Francesco Montorsi, Alberto Briganti, Andrea Gallina, Armando Stabile, Rafael Sanchez-Salas, Xavier Cathelineau, Michael Rink, Andrea Necchi, Pierre I Karakiewicz, Morgan Rouprêt, Anthony Koupparis, Wassim Kassouf, Douglas S Scherr, Guillaume Ploussard, Stephen A Boorjian, Yair Lotan, Prasanna Sooriakumaran, Shahrokh F Shariat

Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, A-1090 Vienna, Austria., Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland., Department of Urology Bichat Hospital, Paris Descartes University, 75877 Paris, France., Division of Surgery and Intervention Science, University College London, London WC1E 6BT, UK., Department of Urology, "Regina Elena" National Cancer Institute, 00128 Rome, Italy., Urology Division, Hartford Healthcare Medical Group, Hartford, CT 06106, USA., Department of Urology, University of Minnesota, Minneapolis, MN 55455, USA., Department of Urology, Urological Research Institute, San Raffaele Scientific Institute, 20132 Milan, Italy., Department of Urology, L'Institut Mutualiste Montsouris, Université Paris Descartes, 75014 Paris, France., Department of Urology, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany., Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy., Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Centre, Montreal, QC H4A 3J1, Canada., Sorbonne Université, GRC n°5, ONCOTYPE-URO, AP-HP, Hôpital Pitié-Salpêtrière, F-75013 Paris, France., Bristol Urological Institute, North Bristol NHS Trust, Southmead Hospital, Bristol BS10 5NB, UK., Department of Urology, McGill University Health Center, Montreal, QC H4A3J1, Canada., Department of Urology, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY 10038, USA., Department of Urology, La Croix du sud Hospital, 314000 Toulouse, France., Department of Urology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA., Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA., Department of Uro-Oncology, University College London Hospital NHS Foundation Trust, London W1T 4EU, UK., Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna General Hospital, A-1090 Vienna, Austria. .