Open vs. robot-assisted radical cystectomy with extracorporeal or intracorporeal urinary diversion for bladder cancer: A pairwise meta-analysis of outcomes and a network meta- analysis of complications by urinary diversion approach.

There are no meta-analyses of randomized controlled trials (RCTs) comparing open radical cystectomy (ORC) with robot-assisted radical cystectomy (RARC), inclusive of both intracorporeal (iRARC) and extracorporeal (hybrid RARC, hRARC) urinary reconstruction.

MEDLINE, Embase, Scopus, the International Clinical Trials Registry Platform and registries were searched in May 2022. Outcomes of interest included recurrence- or progression-free survival (RFS/PFS), margin status and lymph node yield, mean estimated blood loss (EBL) and operating room time (ORT), hospital length of stay (LOS), 90-day complications and readmissions, and quality of life (QoL). Pairwise meta-analyses and network meta-analyses were performed using random-effects models and Bayesian hierarchical random-effects models, respectively.

We found no significant differences between RARC and ORC for oncological and most perioperative outcomes: RFS/PFS (hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.67-1.23); positive surgical margins (odds ratio [OR] 1.05, 95% CI 0.60-1.85); lymph node yield (mean difference [MD] -0.63, 95% CI -2.63-1.37); LOS (MD -0.22, 95% CI -1.10-0.65); overall complications (OR 0.81, 95% CI 0.61-1.07); major complications (OR 0.94, 95% CI 0.69-1.30); readmissions (OR 0.90, 95% CI 0.60-1.35); and QoL (standardized MD -0.02, 95% CI -0.17-0.14). We found significantly lower EBL for RARC compared to ORC (MD -312.61, 95% CI - 447 to -178.22) at the expense of significantly prolonged ORT (MD 82.34 minutes, 95% CI 44.82-119.86). Network meta-analysis did not find significant differences in complications between hRARC and iRARC.

This meta-analysis confirms the equivalence of RARC and ORC with respect to oncological outcomes.

Canadian Urological Association journal = Journal de l'Association des urologues du Canada. 2022 Oct 25 [Epub ahead of print]

Carlos Riveros, Sanjana Ranganathan, Cole Nipper, Kelvin Lim, Michael Brooks, Furkan Dursun, Brian J Miles, Alvin C Goh, Mihir Desai, Zachary Klaassen, Girish S Kulkarni, Christopher J D Wallis, Raj Satkunasivam

Department of Urology, Houston Methodist Hospital, Houston, TX, United States., Department of Urology, University of Texas Health, San Antonio, TX, United States., Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, NY, United States., USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States., Division of Urology, Medical College of Georgia, Augusta University, Augusta, GA, United States., Division of Urology and Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, ON, Canada.