Robotic Assisted Radical Cystectomy vs Open Radical Cystectomy: Systematic Review and Meta-Analysis

Sathianathen, Niranjan; Kalapara, Arveen; Frydenberg, Mark; Lawrentschuk, Nathan; Weight, Christopher J.; Parekh, Dipen J.; Konety, Badrinath R.

doi:10.1016/j.juro.2018.10.006

Cited by 122 publications

(97 citation statements)

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“…The survival rate of LRC in the present study was almost comparable to that of MIRC (LRC or RARC) or that of ORC, as previously reported . In accordance with our results, systemic reviews and recent randomized trials for RARC have shown that oncological outcomes of MIRC are equivalent to those of ORC . Similar to previous reports, 5‐year relapse‐free survival, cancer‐specific survival and overall survival were stratified into pT and pN, and the presence or absence of lymph node dissection, pT and pN were significant factors associated with recurrence on multivariate analysis.…”

Section: Discussionsupporting

confidence: 91%

“…[11][12][13] In accordance with our results, systemic reviews and recent randomized trials for RARC have shown that oncological outcomes of MIRC are equivalent to those of ORC. 3,4,[14][15][16] Similar to previous reports, 5-year relapse-free survival, cancer-specific survival and overall survival were stratified into pT and pN, and the presence or absence of lymph node dissection, pT and pN were significant factors associated with recurrence on multivariate analysis. Whether MIRC increases port-site recurrence or disseminated abdominal recurrence, such as carcinomatous peritonitis, is highly controversial.…”

Section: Discussionsupporting

confidence: 72%

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Oncological outcomes and recurrence patterns after laparoscopic radical cystectomy for bladder cancer: A Japanese multicenter cohort

et al. 2020

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Objective To investigate oncological outcomes and recurrence patterns after laparoscopic radical cystectomy for bladder cancer in a Japanese multicenter cohort, and to explore the risk factors associated with recurrences due to tumor dissemination. Method Laparoscopic radical cystectomies carried out at 10 institutions were included in this retrospective study. Multivariate analyses were carried out to identify the clinical parameters associated with overall recurrences together with specific recurrence types. Kaplan–Meier curves were created to elucidate time to recurrence and survival. Results A total of 411 patients were included after the final analysis. Postoperative pathology was T2 or higher in 196 patients (48%), and lymph node metastasis was present in 46 patients (11%). The median follow‐up period was 23 months, and the 2‐year recurrence‐free and cancer‐specific survival rates were 71.0% and 84.7%, respectively. The recurrence sites involved distant metastasis in 75 patients (18%), local recurrence in 52 patients (13%) and urinary tract recurrence in eight patients (2%). When local recurrence at the cystectomy bed (28 patients; 7%) and abdominal recurrence including peritoneal carcinomatosis or port site recurrence (17 patients; 4%), which might be caused by tumor dissemination, were combined into a single group, prolonged surgical time was a significant risk factor, in addition to high pathological stage (T3–4 and/or positive lymph nodes), positive surgical margins, and variant histology by both univariate and multivariate analyses. Conclusions Our study findings suggest that recurrences after laparoscopic radical cystectomy might be caused by tumor dissemination, and attention should be paid to avoid prolonged surgical time in laparoscopic radical cystectomy.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 72%

Oncological outcomes and recurrence patterns after laparoscopic radical cystectomy for bladder cancer: A Japanese multicenter cohort

et al. 2020

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“…We identified five relevant systematic reviews of RCTs and non‐randomized controlled trials comparing RARC and ORC (Ishii et al., ; Novara et al., ; Tang et al., ; Yuh et al., ; Sathianathen et al., ). These reviews used pooled data derived across all study designs, and none considered evaluation of the quality of evidence as defined by GRADE.…”

Section: Discussionmentioning

confidence: 99%

“…Sathianathen et al., have published the most recent and highest‐quality review to date. Methodological hallmarks include an a priori registered protocol with predefined primary outcomes, a comprehensive search of multiple data sources, and study inclusion irrespective of language of publication status and use of GRADE to assess the quality of evidence on a per‐outcome basis.…”

Section: Discussionmentioning

confidence: 99%

Robot‐assisted vs open radical cystectomy for bladder cancer in adults

et al. 2020

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We conclude that RARC and ORC may have similar outcomes with regard to time to recurrence, rates of major complications, quality of life, and positive surgical margin rates (all low-certainty evidence). We are very uncertain whether the robotic approach reduces rates of minor complications (very-low-certainty evidence), although it probably reduces the risk of blood transfusions substantially (moderate-certainty evidence) and may reduce hospital stay slightly (low-certainty evidence). We were unable to conduct any of the preplanned subgroup analyses to assess the impact of patient age, pathological stage, body habitus, or surgeon expertise on outcomes. This review did not address issues of cost-effectiveness.

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“…Cystectomy and urinary diversion is one of the most complicated procedure in urological operations with nearly 40% of perioperative morbidity. Urinary fistula after ileal conduit is rare, but the management of this complication is challenging [1][2][3][4] . Though ureteroenteric anastomosis and closure of conduit are both in risk of urine leakage, the management was almost similar as below: evaluate to ensure the urinary fistula, drainage the urine out, and then repair the fistula actively or conservatively [4][5][6][7][8] .…”

Section: Introductionmentioning

confidence: 99%

A simple method for conservative treatment of urinary fistula following ileal conduit

Heng²,

Tan³

et al. 2019

Preprint

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Robotic Assisted Radical Cystectomy vs Open Radical Cystectomy: Systematic Review and Meta-Analysis

Cited by 122 publications

References 0 publications

Oncological outcomes and recurrence patterns after laparoscopic radical cystectomy for bladder cancer: A Japanese multicenter cohort

Oncological outcomes and recurrence patterns after laparoscopic radical cystectomy for bladder cancer: A Japanese multicenter cohort

Robot‐assisted vs open radical cystectomy for bladder cancer in adults

A simple method for conservative treatment of urinary fistula following ileal conduit

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