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Perioperative outcomes and safety of robotic vs open cystectomy: a systematic review and meta-analysis of 12,640 cases

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Abstract

Purpose

Robotic radical cystectomy (RRC) has become a commonly utilised alternative to open radical cystectomy (ORC). We performed a systematic review and meta-analysis of RRC vs ORC focusing on perioperative outcomes and safety.

Methods

Medline, EMBASE and CENTRAL were searched from January 2000 to April 2020 following the Preferred Reporting Items for Systematic Review and Meta-analysis Statement for study selection.

Results

In total, 47 studies (5 randomised controlled trials, 42 non-randomised comparative studies) comprising 12,640 patients (6572 ORC, 6068 RRC) were included. There was no difference in baseline demographics between the groups apart from males were more likely to undergo ORC (OR 0.77, 95% CI 0.69–0.85). Those with muscle-invasive disease were more likely to undergo RRC (OR 1.21, 95% CI 1.09–1.34), and those with high-risk non-muscle-invasive bladder cancer were more likely to undergo ORC (OR 0.80, 95% CI 0.72–0.89). RRC had a significantly longer operating time, less blood loss and lower transfusion rate. There was no difference in lymph node yield, rate of positive surgical margins, or Clavien–Dindo Grade I–II complications between the two groups. However, the RRC group were less likely to experience Clavien–Dindo Grade III–IV (OR 1.56, 95% CI 1.30–1.89) and overall complications (OR 1.45, 95% CI 1.26–1.68) than the ORC group. The mortality rate was higher in ORC although this did not reach statistical significance (OR 1.52, 95% CI 0.99–2.35).

Conclusion

RRC has significantly lower blood loss, transfusion rate and is associated with fewer high grade and overall complications compared to ORC.

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Authors and Affiliations

  1. Department of Urology, Royal Alexandra Hospital, Castlehead, Paisley, PA2 9PJ, UK

    Keiran D. Clement & Ahmed H. Gabr

  2. Department of Paediatric Surgery, Royal Hospital for Children, Glasgow, UK

    Emily Pearce

  3. Department of Urology, Minia University, Minia, Egypt

    Ahmed H. Gabr

  4. Department of Urology, Freeman Hospital, The Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK

    Bhavan P. Rai

  5. Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar

    Abdulla Al-Ansari & Omar M. Aboumarzouk

  6. University of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, UK

    Omar M. Aboumarzouk

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OMA conceived the study. KDC, EP and AHG undertook data collection and analysis of results. KDC prepared the initial manuscript. All author’s had overall comment on the finalised article. KDC is the corresponding author and OMA is the guarantor.

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Correspondence to Keiran D. Clement.

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Clement, K.D., Pearce, E., Gabr, A.H. et al. Perioperative outcomes and safety of robotic vs open cystectomy: a systematic review and meta-analysis of 12,640 cases. World J Urol 39, 1733–1746 (2021). https://doi.org/10.1007/s00345-020-03385-8

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