Perioperative outcomes and safety of robotic vs open cystectomy: a systematic review and meta-analysis of 12,640 cases

• Published in: World journal of urology Vol. 39; no. 6; pp. 1733 - 1746
• Main Authors: Clement, Keiran D., Pearce, Emily, Gabr, Ahmed H., Rai, Bhavan P., Al-Ansari, Abdulla, Aboumarzouk, Omar M.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01-06-2021; Springer Nature B.V
• Subjects: Bladder cancer; Blood transfusion; Clinical trials; Demography; Invasiveness; Invited Review; Lymph nodes; Medicine; Medicine & Public Health; Meta-analysis; Nephrology; Oncology; Robotic surgery; Systematic review; Urology; Cystectomy; Bladder cancer; Robotics; Minimally invasive; Meta-analysis
• ISSN: 0724-4983; 1433-8726
• DOI: 10.1007/s00345-020-03385-8

Purpose
Robotic radical cystectomy (RRC) has become a commonly utilised alternative to open radical cystectomy (ORC). We performed a systematic review and meta-analysis of RRC vs ORC focusing on perioperative outcomes and safety.
Methods
Medline, EMBASE and CENTRAL were searched from January 2000 to April 2020 following the Preferred Reporting Items for Systematic Review and Meta-analysis Statement for study selection.
Results
In total, 47 studies (5 randomised controlled trials, 42 non-randomised comparative studies) comprising 12,640 patients (6572 ORC, 6068 RRC) were included. There was no difference in baseline demographics between the groups apart from males were more likely to undergo ORC (OR 0.77, 95% CI 0.69–0.85). Those with muscle-invasive disease were more likely to undergo RRC (OR 1.21, 95% CI 1.09–1.34), and those with high-risk non-muscle-invasive bladder cancer were more likely to undergo ORC (OR 0.80, 95% CI 0.72–0.89). RRC had a significantly longer operating time, less blood loss and lower transfusion rate. There was no difference in lymph node yield, rate of positive surgical margins, or Clavien–Dindo Grade I–II complications between the two groups. However, the RRC group were less likely to experience Clavien–Dindo Grade III–IV (OR 1.56, 95% CI 1.30–1.89) and overall complications (OR 1.45, 95% CI 1.26–1.68) than the ORC group. The mortality rate was higher in ORC although this did not reach statistical significance (OR 1.52, 95% CI 0.99–2.35).
Conclusion
RRC has significantly lower blood loss, transfusion rate and is associated with fewer high grade and overall complications compared to ORC.