Does the Use of a Robot Decrease the Complication Rate Adherent to Radical Cystectomy? A Systematic Review and Meta-Analysis of Studies Comparing Open with Robotic Counterparts

Tzelves, Lazaros; Skolarikos, Andreas; Mourmouris, Panagiotis; Lazarou, Lazaros; Κωστακόπουλος, Νικόλαος; Manatakis, Dimitrios K.; Kural, Ali Rıza

doi:10.1089/end.2019.0226

Cited by 15 publications

(11 citation statements)

References 73 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We found that EBL and blood transfusion rates were significantly lower in patients who received an ICUD rather than those who underwent an ECUD in the present study. Recent meta-analyses comparing RARC with ECUD vs. ORC described significantly lower EBL and blood transfusion rates in RARC than in ORC [5,7,33,34], with this tendency being extended in RARC with ICUD in this study. This could be explained by the influence of pneumoperitoneum throughout the surgery and precise dissection due to three-dimensional magnified visualization.…”

Section: Discussionsupporting

confidence: 57%

“…RC is a technically complex procedure that comprises two major steps: the bladder extirpation phase and the urinary reconstructive phase. With the growing popularity of RARC, the quest for improvement of outcomes has shown some evidence toward better outcomes with ICUD compared to ECUD while maintaining long-term survival outcomes and similar recurrence patterns as well as superior perioperative outcomes and comparable oncological outcomes compared to ORC [31][32][33][34]. It is well-known that the urinary reconstructive phase is the major driver of morbidity.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Intracorporeal versus extracorporeal urinary diversion in robot-assisted radical cystectomy: a systematic review and meta-analysis

et al. 2021

View full text Add to dashboard Cite

This systematic review and meta-analysis aimed to assess and compare the perioperative and oncological outcomes of intracorporeal (ICUD) and extracorporeal (ECUD) urinary diversion following robot-assisted radical cystectomy (RARC). A systematic literature search of articles was performed in PubMed®, Web of Science®, and Scopus® databases according to the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. We included studies that compared patients who underwent RARC with ICUD to those with ECUD. Twelve studies including 3067 patients met the eligibility criteria. There were no significant differences between ICUD and ECUD in overall and major complications, regardless of the period (short-term [≤ 30 days] or mid-term [> 30 days]). Subgroup analyses demonstrated that ICUD performed by high-volume centers exhibited a significantly reduced risk of major complications (short-term: OR 0.57, 95% CI 0.37–0.86, p = 0.008, mid-term: OR 0.66, 95% CI 0.46–0.94, p = 0.02). Patients who underwent ICUD had lower estimated blood loss (MD -102.3 ml, 95% CI − 132.8 to − 71.8, p < 0.00001), less likely to receive blood transfusion rates (OR 0.36, 95% CI 0.20–0.62, p = 0.00003); and these findings were consistent in subgroup analyses by low-volume centers (MD-121.6 ml, 95% CI − 160.9 to − 82.3, p < 0.00001 and OR 0.36, 95% CI 0.20–0.62, p = 0.00003, respectively). ICUD had a higher lymph node yield (MD 3.68, 95% CI 0.80–6.56, p = 0.01). Patients receiving ICUD provided comparable complications, superior perioperative outcomes, and similar oncological outcomes compared with ECUD. Centralization of patients may contribute to a reduction of postoperative complications, while maintaining the advantages.

show abstract

Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Intracorporeal versus extracorporeal urinary diversion in robot-assisted radical cystectomy: a systematic review and meta-analysis

et al. 2021

View full text Add to dashboard Cite

show abstract

“…These results were reached in a patient cohort resembling other published series 39 . However, patients treated with ORC had a median CCI of 5.5 and were not only more comorbid compared to the RARC group, but also to most other published cohorts.…”

Section: Discussionsupporting

confidence: 66%

“…37,38 These results were reached in a patient cohort resembling other published series. 39 However, patients treated with ORC had a median CCI of 5.5 and were not only more comorbid compared to the RARC group, but also to most other published cohorts. Recently, two database analyses including more than 20 000 patients only graded 12.1% patients CCI ≥ 2 and 1.7% patients CCI ≥ 3.…”

Section: Multiple Regression Analysismentioning

confidence: 91%

Robot‐assisted versus open radical cystectomy: A cohort study on perioperative outcomes accounting for stage selection bias and surgical experience

Zeuschner

Linxweiler

Mohr

et al. 2021

Robotics Computer Surgery

View full text Add to dashboard Cite

Background Most comparisons of robot‐assisted (RARC) versus open radical cystectomy (ORC) for urothelial carcinoma do not factor the inherent stage selection bias or surgical experience. Methods We compared the perioperative outcomes of 229 RARC and 335 ORC at a single tertiary referral centre with propensity score matching and multiple regression models, when controlling for tumour and patient characteristics, surgeon's experience and type of urinary diversion. Results RARC had less major complications (19.8% vs. 34.1%) and ICU admissions (6.6% vs. 19.8%), with lower blood loss (400 vs. 500 ml) and transfusion rates. The operating time was longer (336 vs. 286 min), but decreased with surgeon's experience. RARC had less positive surgical margins (3% vs. 8.4%) and a higher lymph node count (14 vs. 11). Conclusions In this large single centre series comparing RARC with ORC controlling for stage selection bias and surgical experience, RARC proved significantly better outcomes, especially with intracorporeal urinary diversion.

show abstract

“…So wird in aktuellen Serien eine 90-Tages-Mortalität von 5-9% beschrieben [4,5], Major-Komplikationen werden bei bis zu 30-40% der Patienten beobachtet [6,7]. Durch den Einsatz minimal-invasiver Techniken wie der robotisch-assistieren RC (RARC) können perioperative Morbidität (und damit auch Mortalität) günstig beeinflusst werden, wie es einzelne Untersuchungen nahelegen [8,9].…”

Section: Introductionunclassified

Beeinträchtigt die robotergestützte radikale Zystektomie das onkologische Ergebnis bei Blasenkrebspatienten?

et al. 2022

View full text Add to dashboard Cite

ZusammenfassungDas Einsatzgebiet der roboterassistierten Chirurgie in der Urologie umfasst mittlerweile ein breites Spektrum an Eingriffen. Wesentlich sind dabei neben rekonstruktiven Eingriffen insbesondere tumorchirurgische Eingriffe wie die radikale Zystektomie. Während Untersuchungen zur perioperativen Qualität der robotisch-assistierten radikalen Zystektomie einen günstigen Einfluss auf die Morbidität (und damit auch Mortalität) nahelegen, bleibt die Frage, inwieweit auch die onkologische Qualität des Eingriffs gemessen am rezidivfreien und Gesamtüberleben beeinflusst.In diesem Kontext werden in dieser Arbeit nach einer umfassenden Literaturrecherche sowohl die Daten retrospektive Kohortenvergleiche zwischen offener und robotischer Zystektomie, Registerdaten zur robotischen Zystektomie sowie die Ergebnisse prospektiv randomisierter Studien dargestellt.Zusammengefasst ist unter onkologischen Gesichtspunkten die robotische der offenen Zystektomie nicht unterlegen. Die Daten des Gesamtüberlebens, des karzinomspezifischen Überlebens und des progressionsfreien Überlebens unterscheiden sich weder in den retrospektiven Kohortestudien, im indirekten Vergleich von Registerdaten und/oder großer Serien noch in den bisherigen prospektiven Untersuchungen. Im Hinblick auf das Auftreten atypische Metastasen nach robotischer Zystektomie fehlen aktuell prospektive Daten, dies nicht das generelle onkologische Outcome zu beeinflussen.Damit ist die robotisch-assistierte Zystektomie auch aus onkologischen Gesichtspunkten eine gute Option für Patienten, bei denen eine Indikation zur radikalen Zystektomie besteht.

show abstract

Does the Use of a Robot Decrease the Complication Rate Adherent to Radical Cystectomy? A Systematic Review and Meta-Analysis of Studies Comparing Open with Robotic Counterparts

Cited by 15 publications

References 73 publications

Intracorporeal versus extracorporeal urinary diversion in robot-assisted radical cystectomy: a systematic review and meta-analysis

Intracorporeal versus extracorporeal urinary diversion in robot-assisted radical cystectomy: a systematic review and meta-analysis

Robot‐assisted versus open radical cystectomy: A cohort study on perioperative outcomes accounting for stage selection bias and surgical experience

Beeinträchtigt die robotergestützte radikale Zystektomie das onkologische Ergebnis bei Blasenkrebspatienten?

Contact Info

Product

Resources

About