Systematic review and cumulative analysis of perioperative outcomes and complications after robot-assisted radical cystectomy - Abstract

CONTEXT: Although open radical cystectomy (ORC) is still the standard approach, laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) have gained popularity.

OBJECTIVE: To report a systematic literature review and cumulative analysis of perioperative outcomes and complications of RARC in comparison with ORC and LRC.

EVIDENCE ACQUISITION: Medline, Scopus, and Web of Science databases were searched using a free-text protocol including the terms robot-assisted radical cystectomy or da Vinci radical cystectomy or robot* radical cystectomy. RARC case series and studies comparing RARC with either ORC or LRC were collected. Cumulative analysis was conducted.

EVIDENCE SYNTHESIS: The searches retrieved 105 papers. According to the different diversion type, overall mean operative time ranged from 360 to 420min. Similarly, mean blood loss ranged from 260 to 480ml. Mean in-hospital stay was about 9 d for all diversion types, with consistently high readmission rates. In series reporting on RARC with either extracorporeal or intracorporeal conduit diversion, overall 90-d complication rates were 59% (high-grade complication: 15%). In series reporting RARC with intracorporeal continent diversion, the overall 30-d complication rate was 45.7% (high-grade complication: 28%). Reported mortality rates were ≤ 3% for all diversion types. Comparing RARC and ORC, cumulative analyses demonstrated shorter operative time for ORC, whereas blood loss and in-hospital stay were better with RARC (all p values < 0.003). Moreover, 90-d complication rates of any-grade and 90-d grade 3 complication rates were lower for RARC (all p values < 0.04), whereas high-grade complication and mortality rates were similar.

CONCLUSIONS: RARC can be performed safely with acceptable perioperative outcome, although complications are common. Cumulative analyses demonstrated that operative time was shorter with ORC, whereas RARC may provide some advantages in terms of blood loss and transfusion rates and, more limitedly, for postoperative complication rates over ORC and LRC.

PATIENT SUMMARY: Although open radical cystectomy (RC) is still regarded as a standard treatment for muscle-invasive bladder cancer, laparoscopic and robot-assisted RC are becoming more popular. Robotic RC can be safely performed with acceptably low risk of blood loss, transfusion, and intraoperative complications; however, as for open RC, the risk of postoperative complications is high, including a substantial risk of major complication and reoperation.

Written by:
Novara G, Catto JW, Wilson T, Annerstedt M, Chan K, Murphy DG, Motttrie A, Peabody JO, Skinner EC, Wiklund PN, Guru KA, Yuh B.   Are you the author?
Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Italy; Academic Urology Unit, University of Sheffield, Sheffield, UK; City of Hope National Cancer Center Duarte, CA, USA; Department of Urology, Herlev University Hospital, Denmark; Division of Cancer Surgery, Peter MacCallum Cancer Centre, St. Andrews Place, East Melbourne, Victoria, Australia; Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium; Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA; Department of Urology, Stanford University, Stanford, CA, USA; Karolinska University Hospital, Urology, Stockholm, Sweden; Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.

Reference: Eur Urol. 2015 Jan 2. pii: S0302-2838(14)01262-7.
doi: 10.1016/j.eururo.2014.12.007

PubMed Abstract
PMID: 25560798 Bladder Cancer Section

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