The impact of robotic surgery in bladder cancer patients

Abstract

Abstract: To investigate the impact of robotic surgery in bladder cancer (BCa) patients, analysing surgical, functional, and oncologic outcomes of robot-assisted radical cystectomy (RARC) in comparing to open radical cystectomy (ORC). A systematic literature search of all randomized controlled trials (RCTs) comparing RARC with ORC was performed in November 2019. For each selected study, the following items were recorded in an Excel (Microsoft, Redmond, United States) sheet: surgical data (operative time, blood loss, transfusion rate, in-hospital stay, complication rates) and oncologic data (positive surgical margins, lymph node yields, disease-free survival, cancer-specific survival, overall survival). We consider 5 RCTs for the analysis including 548 cases (276 cases for RARC and 272 cases for ORC), which fulfilled the predefined inclusion criteria and were included in the final analysis All selected studies presented a LoE 1b. One of the limits presented by RARC was the median operating time. All included studies reported longer OP time when compared to ORC. RARC resulted superior to ORC when considered estimated blood loss (EBL) and transfusion. No significant differences in overall complications (grades I–V) were identified between the treatment groups and the proportion of patients who had major complications (grades III–IV) was also similar between the groups. When considering progression-free survival, recurrence-free survival and BCa-specific survival, RARC demonstrated its non-inferiority to open cystectomy without any risk for port-site metastases. RARC robotic cystectomy is non-inferior to open cystectomy for surgical complications and oncological outcomes. Nevertheless, the supposed benefits of a mini-invasive approach concerning reduced hospital stay and improved postoperative QoL could be not demonstrated. Increased adoption of robotic surgery the therapy of muscle-invasive BCa should lead to future randomised trials to assess if RARC could become the new gold standard for RC