Abstract
To perform an updated systematic review and meta-analysis evaluating patient important outcomes for patients undergoing robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC).
Multiple scientific databases were searched up to July 2018 for randomized controlled trials that compared RARC and ORC. 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.
Five studies with a total of 540 participants were included in this review. There was no difference between RARC and ORC for 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 [SMD -0.03, 95%CI -0.27-0.21]. However, RARC demonstrated a reduced risk of requiring a perioperative blood transfusion [RR 0.58, 95%CI 0.43-0.80] and had a marginally lower duration of hospital stay [RR -0.63 days, 95%CI -1.21- -0.05]. Operative time was longer in the RARC group [MD 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 favors ORC. The overall quality of evidence was judged to be moderate.
Surgical approach does not have a considerable impact on oncological, safety and quality-of-life outcomes for patients undergoing radical cystectomy. The benefits conferred by RARC are the decreased need for blood transfusion and an earlier discharge from hospital.
