TY - JOUR
T1 - Robotic Assisted Radical Cystectomy vs Open Radical Cystectomy
T2 - Systematic Review and Meta-Analysis
AU - Sathianathen, Niranjan J.
AU - Kalapara, Arveen
AU - Frydenberg, Mark
AU - Lawrentschuk, Nathan
AU - Weight, Christopher J.
AU - Parekh, Dipen
AU - Konety, Badrinath R.
N1 - Publisher Copyright:
© 2019 by American Urological Association Education and Research, Inc.
PY - 2019/4/1
Y1 - 2019/4/1
N2 - Purpose:We performed an updated systematic review and meta-Analysis of outcomes important to patients in those undergoing robot-Assisted and open radical cystectomy.Materials and Methods:Multiple scientific databases were searched up to July 2018 for randomized, controlled trials comparing robot-Assisted and open radical cystectomy. The primary outcomes of interest were disease progression, major (Clavien III-V) complications and 90-day quality of life. The quality of evidence was evaluated according to the framework in the Cochrane Handbook for Systematic Reviews of Interventions.Results:Five studies with a total of 540 participants were included in this review. There was no difference between robot-Assisted and open radical cystectomy in disease progression (RR 0.94, 95% CI 0.69-1.29), major complications (RR 1.06, 95% CI 0.75-1.49) or quality of life (standardized mean difference-0.03, 95% CI-0.27-0.21). However, robot-Assisted radical cystectomy demonstrated a reduced risk of perioperative blood transfusion (RR 0.58, 95% CI 0.43-0.80) and a marginally shorter hospital stay (RR-0.63 days, 95% CI-1.21-0.05). Operative time was longer in the robot-Assisted group (mean difference 68.51 minutes, 95% CI 30.55-105.48). There was no statistically significant difference in local recurrence rates between the procedures (RR 2.08, 95% CI 0.96-4.50) but this difference may be clinically significant and it favored open radical cystectomy. The overall quality of evidence was judged to be moderate.Conclusions:Surgical approach does not have a considerable impact on oncologic, safety and quality of life outcomes in patients who undergo radical cystectomy. The benefits conferred by robot-Assisted radical cystectomy are a decreased need for blood transfusion and earlier hospital discharge.
AB - Purpose:We performed an updated systematic review and meta-Analysis of outcomes important to patients in those undergoing robot-Assisted and open radical cystectomy.Materials and Methods:Multiple scientific databases were searched up to July 2018 for randomized, controlled trials comparing robot-Assisted and open radical cystectomy. The primary outcomes of interest were disease progression, major (Clavien III-V) complications and 90-day quality of life. The quality of evidence was evaluated according to the framework in the Cochrane Handbook for Systematic Reviews of Interventions.Results:Five studies with a total of 540 participants were included in this review. There was no difference between robot-Assisted and open radical cystectomy in disease progression (RR 0.94, 95% CI 0.69-1.29), major complications (RR 1.06, 95% CI 0.75-1.49) or quality of life (standardized mean difference-0.03, 95% CI-0.27-0.21). However, robot-Assisted radical cystectomy demonstrated a reduced risk of perioperative blood transfusion (RR 0.58, 95% CI 0.43-0.80) and a marginally shorter hospital stay (RR-0.63 days, 95% CI-1.21-0.05). Operative time was longer in the robot-Assisted group (mean difference 68.51 minutes, 95% CI 30.55-105.48). There was no statistically significant difference in local recurrence rates between the procedures (RR 2.08, 95% CI 0.96-4.50) but this difference may be clinically significant and it favored open radical cystectomy. The overall quality of evidence was judged to be moderate.Conclusions:Surgical approach does not have a considerable impact on oncologic, safety and quality of life outcomes in patients who undergo radical cystectomy. The benefits conferred by robot-Assisted radical cystectomy are a decreased need for blood transfusion and earlier hospital discharge.
KW - bladder neoplasms
KW - complications
KW - cystectomy
KW - quality of life
KW - robotic surgical procedures
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U2 - 10.1016/j.juro.2018.10.006
DO - 10.1016/j.juro.2018.10.006
M3 - Article
C2 - 30321551
AN - SCOPUS:85059774970
SN - 0022-5347
VL - 201
SP - 715
EP - 720
JO - Journal of Urology
JF - Journal of Urology
IS - 4
ER -