Robotic vs. open radical cystectomy in bladder cancer: A systematic review and meta-analysis

• Published in: European journal of surgical oncology Vol. 40; no. 11; pp. 1399 - 1411
• Main Authors: Tang, K, Xia, D, Li, H, Guan, W, Guo, X, Hu, Z, Ma, X, Zhang, X, Xu, H, Ye, Z
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01-11-2014
• Subjects: Bladder cancer; Blood Loss, Surgical; Blood Transfusion - utilization; Cystectomy - methods; Hematology, Oncology and Palliative Medicine; Humans; Length of Stay; Lymph Node Excision - methods; Meta-analysis; Neoplasm, Residual; Open; Operative Time; Radical cystectomy; Robotic Surgical Procedures - methods; Robotic-assisted; Surgery; Treatment Outcome; Urinary Bladder Neoplasms - surgery; Radical cystectomy; Bladder cancer; Robotic-assisted; Open; Meta-analysis
• ISSN: 0748-7983; 1532-2157
• DOI: 10.1016/j.ejso.2014.03.008

Abstract Aims To evaluate the safety and efficacy of robot-assisted radical cystectomy (RARC) compared with open radical cystectomy (ORC) in the treatment of bladder cancer. Methods A systematic search of Medline, Embase databases and the Cochrane Library was performed to identify studies that compared RARC and ORC and were published up to December 2012. Outcomes of interest included demographic and clinical characteristics, perioperative, pathologic variables and complications. Results Although there was a significant difference in the operating time in favor of ORC (WMD: 70.69 min; p  < 0.001), patients having RARC might benefit from significantly fewer total complications (OR: 0.54; p  < 0.001), less blood loss (WMD: −599.03 ml; p  < 0.001), shorter length of hospital stay (WMD: −4.56 d; p  < 0.001), lower blood transfusion rate (OR: 0.13; p  = 0.002), less transfusion needs (WMD: −2.14 units; p  < 0.001), shorter time to regular diet (WMD: −1.57 d; p  = 0.002), more lymph node yield (WMD: 2.18 n; p  = 0.001) and fewer positive lymph node (OR: 0.64; p  = 0.03). There was no significant difference between the RARC and ORC regarding positive surgical margins. Conclusions In early experience, our data suggest that RARC appears to be a safe, feasible and minimally invasive alternative to its open counterpart when performed by experienced surgeons in selected patients.