Robotic surgery and minimally invasive techniques are increasingly taking over on open surgery even in the treatment of muscle-invasive bladder cancer. Oncological and functional results of robotic-assisted radical cystectomy (RARC) seem to be comparable to open procedures.1 However, the costs of the procedures and some doubts about oncology outcomes including the possible relation with atypical recurrences (peritoneal carcinomatosis, extra-pelvic lymph node metastasis, and port-site metastasis) already limit RARC diffusion.
The purpose of this systematic review is to evaluate the current evidence regarding atypical metastases in patients undergoing RARC.2 We performed a systematic search of Medline and NCBI PubMed, Cochrane Central Register of Controlled Trials (CENTRAL) and Google Scholar databases in October 2019. We analyzed all studies (except for case reports, letters to the editor and editorial comments) published after 2003 concerning humans undergone RARC and reporting recurrences with its location.
Although some literature indicates a low incidence of atypical recurrences after RARC, publication bias could influence the evidence. In fact, the available data could have been published only by centers with satisfactory outcomes. Moreover, the learning curve is not fully clarified and a higher robotic surgical experience may reduce the risk of excessive organ handling, tumor violation, spillage of urine and excessive use of pneumoperitoneum. Furthermore, more studies are needed to define whose patients are at higher risk of atypical recurrences. Thus, the real risk of patients undergoing RARC to develop atypical metastases has to be confirmed by further prospective randomized studies.Written by: Francesca Ambrosini, MD, and Stefano Parodi, MD, Resident in Urology, Department of Urology, Policlinico San Martino Hospital, University of Genova, Genoa, Italy; Guglielmo Mantica, MD, Urologist, Department of Urology, Policlinico San Martino Hospital, University of Genova, Genoa, Italy.
- Albisinni, Simone, Alessandro Veccia, Fouad Aoun, Romain Diamand, Francesco Esperto, Francesco Porpiglia, Thierry Roumeguere, and Cosimo De Nunzio. "A systematic review and meta-analysis comparing the outcomes of open and robotic assisted radical cystectomy." Minerva urologica e nefrologica= The Italian journal of urology and nephrology 71, no. 6 (2019): 553.
- Mantica, Guglielmo, Salvatore Smelzo, Francesca Ambrosini, Stefano Tappero, Stefano Parodi, Andrea Pacchetti, Davide De Marchi, Franco Gaboardi, Nazareno Suardi, and Carlo Terrone. "Port-site metastasis and atypical recurrences after robotic-assisted radical cystectomy (RARC): an updated comprehensive and systematic review of current evidences." Journal of Robotic Surgery (2020): 1-8.