A comparison of early complications between open and robot-assisted radical cystectomy.
OBJECTIVE
The aim of our study was to compare early complication rates between the robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC) using a standardized reporting system.


METHODS
From September 2008 to March 2011, 35 and 104 patients underwent ORC and RARC, respectively. Demographics and perioperative and complication data on all patients were reviewed retrospectively and compared between the two groups. All complications were categorized using a modified Clavien reporting system. We also sought to identify independent predictive factors of grade II or greater complications.


RESULTS
There were no significant differences between the ORC and RARC groups with regard to age, body mass index, American Society of Anesthesiologists score, clinical stage, surgical procedure history, or sex. The RARC group had more cases of ileal neobladder urinary diversion (P<0.001). We did not find any differences in terms of pathologic stage or length of stay. The ORC group had more grade II or greater complications (P=0.001), wound problems (P=0.043), multiple complications (P=0.014), greater estimated blood loss (EBL) (P<0.001), and needed more transfusions (P<0.001). A longer operative time was needed in the RARC group, however. Multivariate logistic regression analysis demonstrated that the ORC (P=0.045, odds ratio [95% confidence interval]=2.44 [1.02-5.85]), EBL (>500 mL, P=0.013, 2.75 [1.24-6.10]), and female sex (P=0.028, 4.06 [1.12-14.11]) were independent predictors of grade II or greater complications.


CONCLUSIONS
Our results showed that the RARC group was comparable to the ORC group with respect to complications using the Clavien reporting system. Further long-term and randomized trials are needed, however, because RARC is still not considered the standard therapy for bladder cancer.
Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Hyun Hwan
HH
Sung
Joong-Seo
JS
Ahn
Seong Il
SI
Seo
Seong Soo
SS
Jeon
Han Yong
HY
Choi
Hyun Moo
HM
Lee
Byong Chang
BC
Jeong
D015653:Cystectomy / Q000009:adverse effects* / Q000193:education; D003710:Demography; D005260:Female; D006801:Humans; D059032:Learning Curve; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality; D012371:Robotics / Q000193:education / Q000379:methods*