Comparison of Oncologic Outcomes Following Open and Robotic-assisted Radical Cystectomy with both Extracorporeal and Intracorporeal Urinary Diversion

Murthy, P. Balakrishna; Lone, Zaeem; Muñoz-López, Carlos; Zhang, JJ H.; Thomas, Lewis J.; Caveney, Maxx; Gerber, Daniel; Khanna, Abhinav; Abouassaly, Robert; Haber, Georges-Pascal; Lee, Byron

doi:10.1016/j.urology.2021.03.041

Cited by 10 publications

(8 citation statements)

References 25 publications

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“…Thirteen studies reported the blood transfusion rate during surgery 13 – 17 , 25 , 26 , 30 , 32 , 34 , 39 – 41 . Based on the results of the heterogeneity test (I 2 =85.7%), a random effect model was used.…”

Section: Resultsmentioning

confidence: 99%

Robot-assisted radical cystectomy with intracorporeal urinary diversion: an updated systematic review and meta-analysis of its differential effect on effectiveness and safety

Fu,

Shi,

Fan

et al. 2024

International Journal of Surgery

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Background: Robot-assisted laparoscopic cystectomy with intracorporeal urinary diversion (iRARC) is increasingly being used in recent years. Whether iRARC offers advantages over open radical cystectomy (ORC) remains controversial. This study aimed to compare the difference of perioperative outcomes, oncological outcomes and complications between iRARC and ORC. Methods: The PubMed, Embase, Cochrane Library, Web of Science and CNKI databases were searched in July 2023 according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analyses) statement. Studies were identified to be eligible if they compared perioperative outcomes, oncological outcomes and complications in patients who underwent iRARC with ORC. Results: Twenty-two studies involving 7,020 patients were included. Compared to ORC, iRARC was superior for estimated blood loss [EBL WMD: −555.52; 95% CI, −681.64 to −429.39; P<0.001], blood transfusion rate [OR: 0.16; 95% CI, 0.09 to 0.28; P<0.001], length of hospital stay [LOS WMD: −2.05; 95% CI, −2.93 to −1.17; P<0.001], Clavien-Dindo grades ≥III complication rate [30d: OR: 0.57; 95% CI 0.44 to 0.75; P<0.001; 90d: OR: 0.71; 95% CI 0.60 to 0.84; P<0.001], and positive surgical margin [PSM OR: 0.65; 95% CI 0.49 to 0.85; P=0.002]. However, iRARC had a longer operative time [OT WMD: 68.54; 95%CI 47.41 to 89.67; P<0.001] and a higher rate of ureteroenteric stricture [ UES OR: 1.56; 95% CI 1.16 to 2.11; P=0.003]. Time to flatus, time to bowel, time to regular diet, readmission rate, Clavien-Dindo grades<III complication rate for iRARC were similar to that for ORC. Interestingly, the results of subgroup analysis revealed no difference in EBL between iRARC and ORC when the diversion type was neobladder. When the ileal conduit was selected as the diversion type, the LOS was similar in both procedures. Conclusion: Robot-assisted laparoscopic cystectomy with intracorporeal urinary diversion appears to be superior to open radical cystectomy in terms of effectiveness and safety. However, attention should be paid to the occurrence of ureteroenteric stricture during follow-up.

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Section: Resultsmentioning

confidence: 99%

Robot-assisted radical cystectomy with intracorporeal urinary diversion: an updated systematic review and meta-analysis of its differential effect on effectiveness and safety

Fu,

Shi,

Fan

et al. 2024

International Journal of Surgery

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“…Several retrospective analyses evaluated the benefit of a total intracorporal approach in radical cystectomy and revealed a significantly lower rate of estimated blood loss, a lower rate of perioperative transfusions, a shorter hospitalization, a lower rate of postoperative ileus and a lower rate of complications compared with ORC or RARC+ECUD [15,16 ▪ ,17 ▪ ,18]. In contrast, Hussein et al [19] reported a higher rate of overall complications and readmission rate in patients undergoing RARC+ICUD.…”

Section: Interpreting Current Datamentioning

confidence: 99%

Robotic radical cystectomy – more precision needed?

Walz

Aslani

Sawodny

et al. 2022

Current Opinion in Urology

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Purpose of review Recently, several trials as well as registry-data analyses investigating the role of robot-assisted radical cystectomy with extra or intracorporal urinary diversion were completed and follow up matured. This review aims to comment on the current evidence-based findings and interpret the future role of the robotic approach as a part of the treatment of bladder cancer. Recent findings Numerous trials and registry-data analyses revealed no significant differences in progression-free and overall survival after open radical cystectomy or robot-assisted radical cystectomy irrespective of urinary diversion. Perioperative parameters, especially intraoperative blood loss, transfusions, thromboembolic events, wound infections and hospitalization were significantly increased in open radical cystectomy. Patients’ convalescence, and especially early postsurgical quality of life, was improved by the robotic approach. The highly demanding surgery itself displayed by a flat learning curve required more than 130 surgeries per institution to reach a stable plateau of complications. The performance of high-quality radical cystectomy irrespective of the approach was significantly increased in high-volume centres. Local recurrence occurs in 11% after radical cystectomy. Current research focuses on intraoperatively usable detection methods and instruments to minimize the risk of residual tumour cells. Summary Taken together, the total intracorporal approach in radical cystectomy holds the potential to improve perioperative parameters and reduces hospitalization without impairing oncological performance of the procedure. To provide best results for the patient radical cystectomy and especially the technically challenging total intracorporal procedure will gain importance in bladder cancer treatment but should be limited to high-volume centres.

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“…Though, the eRARC group had shorter operative times (7 vs 6 h, P = .0004). Several retrospective studies comparing iRARC to either open, laparoscopic, and eRARC have recently been published [25 ▪▪ ,26–33].…”

Section: Intracorporeal Urinary Diversionmentioning

confidence: 99%

“…They reported 30-day and 90-day overall and major (CD III–V) complication rates of iRARC (30-day major: 10.0%, 90-day major: 16.9%) were lower than those of eRARC (17.9%, 24.8%) and ORC (21.0%, 26.1%), P = 0.002, 0.015; no significant differences between groups were reported in readmission rates or oncologic outcomes. In the second largest ( n = 916), Murthy et al compared oncological outcomes in ORC, iRARC, and eRARC and found no differences in recurrence rates or any survival endpoint [26]. In a retrospective analysis of 177 bladder cancer patients, Zennami et al compared iRARC to open surgery via a propensity score-match analysis in terms of oncological and perioperative outcomes [27], They report no difference in five-year recurrence-free survival ( P = 0.46), cancer-specific survival ( P = 0.63), and overall survival ( P = 0.71).…”

Section: Intracorporeal Urinary Diversionmentioning

confidence: 99%

Update on robotic cystectomy

Grauer

Wiklund

2021

Current Opinion in Urology

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Purpose of reviewThis article aims to discuss recently published (2019–2021) studies on robot-assisted radical cystectomy (RARC) with attention to evidence comparing intracorporeal (ICUD) and extracorporeal urinary diversion (ECUD) in terms of intraoperative and perioperative metrics.Recent findingsRARC produces equivalent oncological outcomes compared to open radical cystectomy (ORC). The benefits of RARC are most pronounced perioperatively. ICUD has been increasingly used at centers of excellence as it reduces intestinal exposure, which may incrementally minimize morbidity compared to ECUD or ORC. As the learning curve for ICUD diversion has flattened, retrospective analyses have emerged that suggest this technique may hold benefit over both ORC and RARC with ECUD, though current data is conflicting, and a randomized controlled study is forthcoming.SummaryORC is the current ‘gold standard’ management for muscle-invasive bladder cancer. Based on the premise of the minimization of perioperative morbidity, the development of RARC, most recently with ICUD, seeks to improve patient outcomes. Despite a protracted learning curve, many expert bladder cancer centers have adopted an intracorporeal approach. As more centers adopt, refine, and climb the learning curve for ICUD, a clearer insight of its effect on morbidity will be revealed—informing further adoption of the technique.

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Comparison of Oncologic Outcomes Following Open and Robotic-assisted Radical Cystectomy with both Extracorporeal and Intracorporeal Urinary Diversion

Cited by 10 publications

References 25 publications

Robot-assisted radical cystectomy with intracorporeal urinary diversion: an updated systematic review and meta-analysis of its differential effect on effectiveness and safety

Robot-assisted radical cystectomy with intracorporeal urinary diversion: an updated systematic review and meta-analysis of its differential effect on effectiveness and safety

Robotic radical cystectomy – more precision needed?

Update on robotic cystectomy

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