Matched Comparison of Robotic-assisted and Open Radical Cystectomy

• Published in: Urology (Ridgewood, N.J.) N.J.), 2012-06, Vol.79 (6), p.1303-1309
• Main Authors: Styn, Nicholas R, Montgomery, Jeffery S, Wood, David P, Hafez, Khaled S, Lee, Cheryl T, Tallman, Christopher, He, Chang, Crossley, Heather, Hollenbeck, Brent K, Weizer, Alon Z
• Format: Article
• Language: English
• Subjects: Aged; Biological and medical sciences; Cystectomy - methods; Female; Humans; Male; Matched-Pair Analysis; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Robotics; Treatment Outcome; Urinary Bladder Neoplasms - surgery; Urology
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2012.01.055

Objective To evaluate our initial robotic-assisted radical cystectomy (RARC) experience compared with a robust open radical cystectomy (ORC) series performed at a single institution using a matched-pair analysis. Although early results suggest that RARC is safe, with favorable perioperative and early oncologic outcomes, limited data exist comparing ORC and RARC. Methods RARC and ORC patients were identified through a prospectively maintained institutional review board-approved bladder cancer database. RARC and ORC cases performed from September 2007 to November 2010 were matched 1:2 by age, sex, urinary diversion, and clinical stage. The perioperative, complication, and pathologic outcomes were compared. Results A total of 50 RARC and 100 ORC cases were reviewed, with a median follow-up of 8 and 13.5 months, respectively. No differences in the demographic parameters were present between the 2 groups. RARC was associated with a significantly decreased median estimated blood loss (350 vs 475 mL) and 30-day transfusion rate (2% vs 24%) but with longer operative times (454.9 vs 349.1 minutes). No difference was found in the rate of 30-day minor or major Clavien complications, length of stay, or 30-day readmissions between groups. The 90-day mortality rate was 3% versus 0% for ORC and RARC, respectively. No difference in the final pathologic findings, number of lymph nodes removed, or margin status was identified. Conclusion Early experience with RARC compared with a robust ORC experience demonstrated similar perioperative and pathologic outcomes. Continued experience with RARC has the potential to bring improved perioperative results.