Robotic Assisted Radical Cystectomy vs Open Radical Cystectomy: Systematic Review and Meta-Analysis

Niranjan J. Sathianathen, Arveen Kalapara, Mark Frydenberg, Nathan Lawrentschuk, Christopher J. Weight, Dipen J Parekh, Badrinath R. Konety

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)715-720
Number of pages6
JournalThe Journal of urology
Volume201
Issue number4
DOIs
StatePublished - Apr 1 2019

Fingerprint

Cystectomy
Robotics
Meta-Analysis
Quality of Life
Blood Transfusion
Disease Progression
Operative Time
Length of Stay
Randomized Controlled Trials
Databases
Safety
Recurrence

Keywords

  • bladder neoplasms
  • complications
  • cystectomy
  • quality of life
  • robotic surgical procedures

ASJC Scopus subject areas

  • Urology

Cite this

Sathianathen, N. J., Kalapara, A., Frydenberg, M., Lawrentschuk, N., Weight, C. J., Parekh, D. J., & Konety, B. R. (2019). Robotic Assisted Radical Cystectomy vs Open Radical Cystectomy: Systematic Review and Meta-Analysis. The Journal of urology, 201(4), 715-720. https://doi.org/10.1016/j.juro.2018.10.006

Robotic Assisted Radical Cystectomy vs Open Radical Cystectomy : Systematic Review and Meta-Analysis. / Sathianathen, Niranjan J.; Kalapara, Arveen; Frydenberg, Mark; Lawrentschuk, Nathan; Weight, Christopher J.; Parekh, Dipen J; Konety, Badrinath R.

In: The Journal of urology, Vol. 201, No. 4, 01.04.2019, p. 715-720.

Research output: Contribution to journalArticle

Sathianathen, NJ, Kalapara, A, Frydenberg, M, Lawrentschuk, N, Weight, CJ, Parekh, DJ & Konety, BR 2019, 'Robotic Assisted Radical Cystectomy vs Open Radical Cystectomy: Systematic Review and Meta-Analysis', The Journal of urology, vol. 201, no. 4, pp. 715-720. https://doi.org/10.1016/j.juro.2018.10.006
Sathianathen, Niranjan J. ; Kalapara, Arveen ; Frydenberg, Mark ; Lawrentschuk, Nathan ; Weight, Christopher J. ; Parekh, Dipen J ; Konety, Badrinath R. / Robotic Assisted Radical Cystectomy vs Open Radical Cystectomy : Systematic Review and Meta-Analysis. In: The Journal of urology. 2019 ; Vol. 201, No. 4. pp. 715-720.
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abstract = "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.",
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AU - Lawrentschuk, Nathan

AU - Weight, Christopher J.

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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.

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