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Perioperative complications and oncological outcomes of open versus robotic-assisted radical cystectomy: a propensity score-matched study

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Abstract

Purpose

To conduct a comparative effectiveness analysis between robot-assisted radical cystectomy (RARC) and open approach (ORC).

Materials and methods

A retrospective cohort study was conducted involving all patients undergoing radical cystectomy and urinary diversion for invasive bladder cancer at our institution from 2010 to 2018. Of a total 296 patients, we matched ORC and RARC cases based on age, BMI, Charlson comorbidity index, pathological TN staging of the tumor, prior radiotherapy, and type of diversion. The perioperative complications and oncological outcomes were compared.

Results

Eighty-nine patients were matched in the ORC and RARC groups. The median operative time was longer in RARC group (430 min) than that of ORC group (372 min) (p = 0.03); however, the median estimated blood loss (EBL) was significantly lower in RARC group (500 ml) than that of ORC (700 ml) (p < 0.0001). The median length of hospital stay (LOS) was significantly reduced in the RARC group (7 days) compared to the ORC group (8 days) (p = 0.02). There were no significant differences between both groups in 30- and 90-day postoperative complications (p = 0.3 and p = 0.2, respectively). A total of 68 deaths (38.2%) were observed, of which 36 (40.4%) were in ORC group while 32 (36%) were in RARC group (p = 0.5). The results were comparable in both groups regarding 5-year survival rate and cancer-specific survival (p = 0.3 and p = 0.1, respectively).

Conclusion

RARC showed better perioperative outcomes in the form of less EBL and shortened LOS compared to ORC group. However, both RARC and ORC provide similar postoperative oncologic control, in terms of similar positive surgical margins, cancer-specific rates, and 5-year survival rates.

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Availability of data and materials

The datasets used and analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

The authors received no financial support for the research, authorship, and publication of this article.

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Authors and Affiliations

  1. Department of Urology, University of Minnesota, Minneapolis, MN, USA

    Peter Hanna, Joseph Zabell & Christopher Warlick

  2. Department of Urology, Aswan University, Aswan, Egypt

    Peter Hanna

  3. Department of Urology, Rush University, Chicago, IL, USA

    Badrinath Konety

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  1. Peter Hanna
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  2. Joseph Zabell
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Contributions

Peter Hanna: protocol development, data collection, data analysis, and manuscript writing. Joseph Zabell: manuscript editing. Badrinath Konety: project development and manuscript editing. Christopher Warlick: project development, manuscript editing, and critical revision.

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Correspondence to Peter Hanna.

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Ethics approval and consent to participate

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by University of Minnesota Institutional Review Board No. 1053M65001.

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Hanna, P., Zabell, J., Konety, B. et al. Perioperative complications and oncological outcomes of open versus robotic-assisted radical cystectomy: a propensity score-matched study. World J Urol 42, 220 (2024). https://doi.org/10.1007/s00345-024-04907-4

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