Comparing robotic, laparoscopic and open cystectomy: a systematic review and meta-analysis

Fonseka, Thomas; Ahmed, Kamran; Froghi, Saied; Khan, Shahid; Dasgupta, Prokar; Khan, Mohammad Shamim

doi:10.4081/aiua.2015.1.41

Cited by 54 publications

(41 citation statements)

References 35 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…These meta-analyses have concluded that RARC is associated with lower perioperative complications, reduced LOS, higher lymph node yield, lower transfusion requirement and equivocal PSM. The current meta-analysis comprising of pooled data with 239 patients from four RCTs does not support the conclusions from non-RCT meta-analysis [7, 8, 10, 20]. The results of the current meta-analysis show that RARC is associated with lower EBL, lower wound complications rate and longer operating times.…”

Section: Discussioncontrasting

confidence: 68%

“…Previously, there have been four other systematic reviews on this topic, however these included both retrospective and prospective comparative studies which were at high risk of selection, reporting and publication bias [7, 8, 10, 20]. These meta-analyses have concluded that RARC is associated with lower perioperative complications, reduced LOS, higher lymph node yield, lower transfusion requirement and equivocal PSM.…”

Section: Discussionmentioning

confidence: 99%

“…Previous systematic reviews with meta-analyses were conducted to determine the benefits for RARC, and concluded that patients undergoing RARC have a lower post-operative morbidity, a shorter LOS and higher lymph node yield compared to open radical cystectomy (ORC) [7–10]. However, these reviews incorporated retrospective and prospective cohort studies which are subject to significant bias.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Robotic Assisted Radical Cystectomy with Extracorporeal Urinary Diversion Does Not Show a Benefit over Open Radical Cystectomy: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

et al. 2016

View full text Add to dashboard Cite

BackgroundThe number of robotic assisted radical cystectomy (RARC) procedures is increasing despite the lack of Level I evidence showing any advantages over open radical cystectomy (ORC). However, several systematic reviews with meta-analyses including non-randomised studies, suggest an overall benefit for RARC compared to ORC. We performed a systematic review with meta-analysis of randomised controlled trials (RCTs) to evaluate the perioperative morbidity and efficacy of RARC compared to ORC in patients with bladder cancer.MethodsLiterature searches of Medline/Pubmed, Embase, Web of Science and clinicaltrials.gov databases up to 10th March 2016 were performed. The inclusion criteria for eligible studies were RCTs which compared perioperative outcomes of ORC and RARC for bladder cancer. Primary objective was perioperative and histopathological outcomes of RARC versus ORC while the secondary objective was quality of life assessment (QoL), oncological outcomes and cost analysis.ResultsFour RCTs (from 5 articles) met the inclusion criteria, with a total of 239 patients all with extracorporeal urinary diversion. Patient demographics and clinical characteristics of RARC and ORC patients were evenly matched. There was no significant difference between groups in perioperative morbidity, length of stay, positive surgical margin, lymph node yield and positive lymph node status. RARC group had significantly lower estimated blood loss (p<0.001) and wound complications (p = 0.03) but required significantly longer operating time (p<0.001). QoL was not measured uniformly across trials and cost analysis was reported in one RCTs. A test for heterogeneity did highlight differences across operating time of trials suggesting that surgeon experience may influence outcomes.ConclusionsThis study does not provide evidence to support a benefit for RARC compared to ORC. These results may not have inference for RARC with intracorporeal urinary diversion. Well-designed trials with appropriate endpoints conducted by equally experienced ORC and RARC surgeons will be needed to address this.

show abstract

Section: Discussioncontrasting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Robotic Assisted Radical Cystectomy with Extracorporeal Urinary Diversion Does Not Show a Benefit over Open Radical Cystectomy: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

et al. 2016

View full text Add to dashboard Cite

show abstract

“…The laparoscopic group showed shorter hospitalization time; however, the latter data could be also influenced by the different behaviour among the study centers; there was no difference considering all the other endpoints. As already reported in other studies comparing laparoscopic and robotic surgery, the rate of estimated blood loss and days of hospitalization are variable and often depend on the experience of the surgeon in laparoscopic and robotic techniques [29,30]. Most of the stenosis in our cohort involved the distal ureter.…”

Section: Discussionmentioning

confidence: 71%

Laparoscopic and robotic ureteral stenosis repair: a multi-institutional experience with a long-term follow-up

et al. 2016

View full text Add to dashboard Cite

The treatment of ureteral strictures represents a challenge due to the variability of aetiology, site and extension of the stricture; it ranges from an end-to-end anastomosis or reimplantation into the bladder with a Boari flap or Psoas Hitch. Traditionally, these procedures have been done using an open access, but minimally invasive approaches have gained acceptance. The aim of this study is to evaluate the safety and feasibility and perioperative results of minimally invasive surgery for the treatment of ureteral stenosis with a long-term follow-up. Data of 62 laparoscopic (n = 36) and robotic (n = 26) treatments for ureteral stenosis in 9 Italian centers were reviewed. Patients were followed according to the referring center's protocol. Laparoscopic and robotic approaches were compared. All the procedures were completed successfully without open conversion. Average estimated blood loss in the two groups was 91.2 ± 71.9 cc for the laparoscopic and 47.2 ± 32.3 cc for the robotic, respectively (p = 0.004). Mean days of hospitalization were 5.9 ± 2.4 for the laparoscopic group and 7.6 ± 3.4 for the robotic group (p = 0.006).No differences were found in terms of operative time and post-operative complications. After a median followup of 27 months, the robotic group yielded 2 stenosis recurrence, instead the laparoscopic group shows no cases of recurrence (p = 0.091). Minimally invasive approach for ureteral stenosis is safe and feasible. Both robotic and pure laparoscopic approaches may offer good results in terms of perioperative outcomes, low incidence of complications and recurrence.

show abstract

“…Both laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) have longer operating time (RARC more than LRC), but studies show both produce better surgical outcomes with reduced blood loss and shorter length of stay in the hospital [49]. Another important point to factor in is the challenging and long learning curve associated with both LRC and RARC.…”

Section: Radical Cystectomymentioning

confidence: 99%

Current Concepts in the Management of Muscle Invasive Bladder Cancer

Krishna

Konety

2016

Indian J Surg Oncol

View full text Add to dashboard Cite

Bladder cancer is the ninth most common cancer in the world. Twenty to twenty-five percent of all newly diagnosed bladder cancers are muscle invasive in nature, and further, 20-25% of patients who are diagnosed with high-risk nonmuscle invasive disease will eventually progress to muscle invasive disease in due course of time irrespective of adjuvant intravesical therapies. Availability of newer imaging modalities improves appropriate identification of patients with muscle invasive disease. Radical cystectomy remains the mainstay of treatment for management of muscle invasive disease. Availability of neoadjuvant chemotherapy has improved overall survival. Risk stratification systems are now in consideration to identify patients who benefit maximally from neoadjuvant chemotherapy. Urinary diversion is a major cause of morbidity in these patients, and several strategies are being employed to reduce morbidity. In this article, we review available literature on various aspects of management of muscle invasive disease. Histologically, over 90% of bladder tumors are transitional cell carcinomas. The other subtypes, such as squamous cell and adenocarcinoma, are uncommon and account for 5 and <2%, respectively. Bladder cancer is a heterogeneous disease with a variable natural progression. Urothelial carcinomas can have a component of Bvariant histology^such as squamous differentiation, micropapillary, or adenocarcinoma. Micropapillary variant of urothelial carcinoma is associated with worse prognosis than pure urothelial carcinoma. Around 70% of the patients present with tumors that are superficial and have a tendency to recur. The remaining 30% present with muscle invasive tumors [4]. PathologyLow-grade tumors represent 50-60% of the cases. Majority of the tumors are stage Ta, i.e., confined to the urothelium. These tumors tend to recur and generally require repeated transurethral resection (TURBT) and surveillance cystoscopies [5].High-grade (HG) lesions account for 20-25% of all new cases. These lesions can either be sessile or papillary lesions. These tumors have a tendency to invade into the bladder wall if left untreated, especially in the presence of carcinoma in situ (CIS). Despite treatment in the form TURBT and chemotherapy, more than 20% of the patients with high-grade lesions progress to muscle invasive bladder cancer (MIBC) [6,7]. This has led to a lot of controversy regarding aggressive treatment in the form of early radical cystectomy vs. TURBT along with intravesical therapy, particularly in patients with HG

show abstract

Comparing robotic, laparoscopic and open cystectomy: a systematic review and meta-analysis

Cited by 54 publications

References 35 publications

Robotic Assisted Radical Cystectomy with Extracorporeal Urinary Diversion Does Not Show a Benefit over Open Radical Cystectomy: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Robotic Assisted Radical Cystectomy with Extracorporeal Urinary Diversion Does Not Show a Benefit over Open Radical Cystectomy: A Systematic Review and Meta-Analysis of Randomised Controlled Trials

Laparoscopic and robotic ureteral stenosis repair: a multi-institutional experience with a long-term follow-up

Current Concepts in the Management of Muscle Invasive Bladder Cancer

Contact Info

Product

Resources

About