Complications and health-related quality of life after robot-assisted versus open radical cystectomy: a systematic review and meta-analysis of four RCTs

Lauridsen, Susanne Vahr; Tønnesen, Hanne; Jensen, Bente Thoft; Neuner, Bruno; Thind, Peter; Thomsen, Thordis

doi:10.1186/s13643-017-0547-y

Cited by 35 publications

(22 citation statements)

References 47 publications

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“…However, the study included in the meta-analysis was only one RCT and unpersuasive. Lauridsen et al 6 also conducted a meta-analysis that included four RCTs, but the results were not comprehensive and only included complications and health-related quality of life. Tang JQ et al 15 performed a meta-analysis that only focused on RARC versus ORC.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Many studies have compared the advantages and disadvantages between MIRC (LRC or RARC) and ORC. [6][7][8][9][10][11][12][13][14][15] For example, Tang K et al 14 performed a meta-analysis and found that RARC seems to be a safer and less invasive treatment than ORC. Tang JQ et al 15 also performed a meta-analysis that suggested that RARC is a more minimally invasive treatment than ORC for BCa and has the advantage of reducing bleeding.…”

Section: Introductionmentioning

confidence: 99%

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Minimally invasive versus open radical cystectomy for bladder cancer: A systematic review and meta-analysis

et al. 2019

J Int Med Res

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Background We performed a systematic review and meta-analysis to evaluate the efficacy and safety of minimally invasive radical cystectomy (MIRC) versus open radical cystectomy (ORC) for bladder cancer. Methods We searched the EMBASE and MEDLINE databases to identify randomized controlled trials (RCTs) of MIRC versus ORC in the treatment of bladder cancer. Results Eight articles describing nine RCTs (803 patients) were analyzed. No significant differences were found between MIRC and ORC in two oncologic outcomes: the recurrence rate and mortality. Additionally, no significant differences were found in three pathologic outcomes: lymph node yield, positive lymph nodes, and positive surgical margins. With respect to perioperative outcomes, however, MIRC showed a significantly longer operating time, less estimated blood loss, lower blood transfusion rate, shorter time to regular diet, and shorter length of hospital stay than ORC. The incidence of complications was similar between the two techniques. We found no statistically significant differences in the above outcomes between robot-assisted radical cystectomy and ORC or between laparoscopic radical cystectomy and ORC with the exception of the complication rate. Conclusions MIRC is an effective and safe surgical approach in the treatment of bladder cancer. However, a large-scale multicenter RCT is needed to confirm these findings.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Minimally invasive versus open radical cystectomy for bladder cancer: A systematic review and meta-analysis

et al. 2019

J Int Med Res

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“…Conversely, early randomized controlled trials failed to find any differences in complications at 90 days between RARC and ORC . As the last meta‐analysis on this subject was carried out in 2017, a significant body of novel data including both randomized (RCTs) and NRCTs have emerged, adding new evidence to the topic …”

Section: Introductionmentioning

confidence: 99%

Comparison of perioperative complications and health‐related quality of life between robot‐assisted and open radical cystectomy: A systematic review and meta‐analysis

et al. 2019

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To compare postoperative complications and health‐related quality of life of patients undergoing robot‐assisted radical cystectomy with those of patients undergoing open radical cystectomy. A systematic search was carried out according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses statement. A pooled meta‐analysis was carried out to assess the differences between robot‐assisted radical cystectomy and open radical cystectomy according to randomized and non‐randomized comparative studies, respectively. We identified six randomized comparative studies and 31 non‐randomized comparative studies. Most robot‐assisted radical cystectomy patients were treated with extracorporeal urinary diversion. Robot‐assisted radical cystectomy was associated with longer operative times, and lower blood loss and transfusion rates compared with open radical cystectomy in both randomized comparative studies and non‐randomized comparative studies. There was no significant difference between robot‐assisted radical cystectomy and open radical cystectomy in the rate of patients with any or major complications within 90 days both in randomized comparative studies and non‐randomized comparative studies. Non‐randomized comparative studies reported a lower rate of complications at 30 days, mortality at 90 days and length of stay for patients treated with robot‐assisted radical cystectomy, which were not confirmed in randomized comparative studies. Additionally, there were no differences in postoperative quality of life score assessment at 3 and 6 months between robot‐assisted radical cystectomy and open radical cystectomy. Robot‐assisted radical cystectomy is associated with less blood loss and lower transfusion rates. There is no difference in complications, length of stay, mortality, and quality of life between robot‐assisted radical cystectomy and open radical cystectomy. Data from non‐randomized comparative studies favor perioperative outcomes in robot‐assisted radical cystectomy patients, the failure to confirm in randomized comparative studies, likely due to bias in study design and reporting. Further randomized comparative studies comparing postoperative complications and quality of life between robot‐assisted radical cystectomy with intracorporeal urinary diversion and open radical cystectomy are required to assess potential differences between these two surgical approaches.

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“…In the subgroup of patients with ileal conduit, complication (grade III and IV) happened in more than half. Since it is known, that the highest number of life threatening complications is linked to urine leakage, with later intestinal complications due to urine contact with bowel anastomosis, in selected cases of very high load of the disease or poor general status, ureterocuntaneostomy has also to be taken into consideration, when deciding on the type of urine diversion [ 26 ]. It is also important, that most of the patients included into the study were in poor general condition.…”

Section: Disscussionmentioning

confidence: 99%

Robot assisted radical cystectomy - first Polish clinical outcomes

Adamczyk

Juszczak²,

Pobłocki

et al. 2018

CEJU

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IntroductionUrothelial cell carcinoma is the most common neoplasm of the genito-urinary tract, which, in advanced stages, is treated with radical cystectomy with pelvic lymphadenectomy. It can be performed by an open or minimally invasive approach (laparoscopic and robot-assisted radical cystectomy).Large meta-analyses showed a significantly lower complication rate in the RARC (robot-assisted radical cystectomy) group compared to ORC (open radical cystectomy) in thirty and ninety days after surgery, with similar oncological and functional outcomes. The clinical outcomes of the first forty Polish RARC are explored in this article.Material and methodsThe Polish Radical Robotic Cystectomy Program (PRRC) was started in 2016 at the Nicolaus Copernicus Hospital in Toruń. Forty consecutive patients, with indications for cystectomy were included into the study. During radical robot-assisted cystectomy, obturator, external, internal, common iliac and presacral lymph nodes were dissected. Oncological outcomes, early complication rate, and the clinical variables were analyzed.ResultsThe mean age in the study group was sixty-seven years, with the majority of patients being overweight and assessed as American Society of Anesthesiology Scale (ASA) – ASA III and ASA IV (2/3 of patients).RARC was performed, with the median time of surgery being 324 minutes (170 minutes being the shortest). Mean blood loss was 365 ml (lowest – 50 ml), and only 2 patients required intraoperative blood transfusion.Twenty patients had ileal conduit, and nineteen had other methods of urinary diversion. Only twenty-nine out of forty patients had minor complications (Clavien I and II), 11 had Clavien III and IV. Clavien V was not present. Only 3 patients required reoperation.ConclusionsRARC is a reproducible oncological procedure, which can be safely performed in centers with robotic expertise, with acceptable operative time, complications, and functional and oncologic outcomes.

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Complications and health-related quality of life after robot-assisted versus open radical cystectomy: a systematic review and meta-analysis of four RCTs

Cited by 35 publications

References 47 publications

Minimally invasive versus open radical cystectomy for bladder cancer: A systematic review and meta-analysis

Minimally invasive versus open radical cystectomy for bladder cancer: A systematic review and meta-analysis

Comparison of perioperative complications and health‐related quality of life between robot‐assisted and open radical cystectomy: A systematic review and meta‐analysis

Robot assisted radical cystectomy - first Polish clinical outcomes

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