Oncologic outcomes after robot-assisted versus open radical cystectomy: a systematic review and meta-analysis

Purpose The efficacy of RARC in oncologic outcomes compared ORC is controversial. We assess potential differences in oncologic outcomes between robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC). Methods We performed the literature search systematically according to the Prefe...

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Bibliographic Details
Published in:World journal of urology 2019-08, Vol.37 (8), p.1557-1570
Main Authors: Iwata, Takehiro, Kimura, Shoji, Foerster, Beat, Fossati, Nicola, Briganti, Alberto, Karakiewicz, Pierre I., Gust, Kilian M., Egawa, Shin, Nasu, Yasutomo, Abufaraj, Mohammad, Shariat, Shahrokh F.
Format: Article
Language:English
Subjects:
Cystectomy - methods
Humans
Invited Review
Lymph nodes
Lymphatic system
Medicine
Medicine & Public Health
Meta-analysis
Nephrology
Oncology
Reviews
Robotic surgery
Robotic Surgical Procedures
Survival
Systematic review
Treatment Outcome
Urinary Bladder Neoplasms - surgery
Urology
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Summary:Purpose The efficacy of RARC in oncologic outcomes compared ORC is controversial. We assess potential differences in oncologic outcomes between robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC). Methods We performed the literature search systematically according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. A pooled meta-analysis was performed to assess the difference in oncologic outcomes between RARC and ORC, separately in randomized controlled trials (RCTs) and non-randomized studies (NRCTs). Results Five RCTs and 28 NRCTs were included in this systematic review and meta-analysis. There was no difference in the rate of overall positive surgical margin (PSM) in RCTs, while NRCTs showed a lower rate for RARC. There was no difference in the soft tissue PSM rate between RARC and ORC in both RCTs and NRCTs. There was no difference in the lymph node yield by standard and extended lymph node dissection between RARC and ORC in both RCTs and NRCTs. There was no significant difference in survival outcomes between RARC and ORC in both RCTs and NRCTs. Conclusions Based on the current evidence, there is no difference in the rate of PSMs, lymph node yield, recurrence rate and location as well as short-term survival outcomes between RARC and ORC in RCTs. In NRCTs, only PSM rates were better for RARC compared to ORC, but this was likely due to selection and reporting bias which are inherent to retrospective study designs.
ISSN:0724-4983
1433-8726
DOI:10.1007/s00345-019-02708-8