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

Abstract

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.

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

“…Fifteen studies have described PSM, with a total of 3710 patients 13 – 15 , 17 , 25 , 26 , 28 , 31 – 35 , 38 – 40 . Heterogeneity test results suggest I 2 =0%, using the fixed-effects model.…”

“…In terms of 30-day 13 , 15 , 25 , 34 – 40 and 90-day 13 – 15 , 25 , 30 – 32 , 34 , 36 , 38 , 41 overall complication rate, we found that iRARC approaches had a decreased risk of the overall complication rate (30 days: OR: 0.53; 95% CI 0.33–0.87; P =0.012 Fig. 5 A; 90 days: OR: 0.87; 95% CI 0.77–0.98; P =0.019 Fig.…”

Outcomes of robotic‐assisted versus open radical cystectomy in a large‐scale, contemporary cohort of bladder cancer patients

“…Although the NIS does provide details regarding robotic versus open surgery type, no reliable information is available if urinary diversion was performed extracorporeally or intracorporeally in RARC patients. 30,31 Moreover, the conceptualization and reporting guidelines of the NIS strongly prohibits reporting low numbers of events to preserve the nonidentifiable nature of its population. As a consequence, marginal differences may have not been captured within the current manuscript.…”

“…Moreover, median length of stay (LOS) was shorter in RARC (6 vs. 7days; p < 0.001). Conversely, median THC (31,486 vs. 27,162$; p < 0.001) were higher in RARC. Multivariable logistic regression-derived odds ratios addressing transfusion (0.49), intraoperative (0.53), wound (0.68), and pulmonary (0.71) complications favored RARC (all p < 0.01).…”

Last Resort from Nursing Shortage? Comparative Cost Analysis of Open vs. Robot-Assisted Partial Nephrectomies with a Focus on the Costs of Nursing Care

“…Some studies even indicate cost savings in high-volume centers compared to open surgery [ 5 , 8 , 9 , 10 ]. Of great importance, lower morbidity, with at least equivalent oncologic outcomes compared with the open approach, has been proven for almost all robot-assisted interventions [ 11 , 12 , 13 , 14 , 15 , 16 ].…”