title: Robotic versus open radical cystectomy: prospective comparison of perioperative and pathologic outcomes in Japan.
abstract: OBJECTIVE
  In Japan, no study has compared the perioperative outcomes observed between robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC). This study aimed at a prospective comparison of the perioperative outcomes between RARC and ORC performed by a single surgeon.
  
  
  METHODS
  Between 2008 and 2011, 26 bladder cancer patients underwent radical cystectomy by one surgeon, 11 robotically and 15 by open procedure. We prospectively collected perioperative and pathological data for these 26 patients, and retrospectively compared these two different surgical procedures.
  
  
  RESULTS
  The RARC cohort had a significant decrease in both estimated blood loss (656.9 vs. 1788.7 ml, P=0.0015) and allogeneic transfusion requirement (0 vs. 40%, P=0.0237). The total operative time was almost the same (P=0.2306) but increased duration of bladder removal and lymphadenectomy was observed in the RARC cohort (P=0.0049). Surgery-related complication rates within 30 days were not significantly different (P=0.4185). Positive surgical margin was observed in three patients in the ORC cohort and in one patient in the RARC cohort (P=0.4664). The RARC cohort had a larger number of removed lymph nodes than the ORC cohort, and the difference was statistically significant (20.7 vs. 13.8, P=0.0421).
  
  
  CONCLUSIONS
  We confirmed that RARC is safe and yields acceptable outcomes in comparison with ORC for the treatment of bladder cancer if it is performed by a surgeon who has experience of over 60 cases of robot-assisted radical prostatectomy. It is hoped that RARC will gain acceptance in Japan as a minimally invasive surgery for muscle-invasive bladder cancer.
authors.affiliation: Department of Urology, Tokyo Medical University, 6-7-1 Nishi-shinjuku, Shinjuku-ku, Tokyo 160-0023, Japan. gonta@tokyo-med.ac.jp
authors.forename: Tatsuo
authors.initials: T
authors.lastname: Gondo
authors.forename: Kunihiko
authors.initials: K
authors.lastname: Yoshioka
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Nakagami
authors.forename: Hidenori
authors.initials: H
authors.lastname: Okubo
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Naoya
authors.initials: N
authors.lastname: Satake
authors.forename: Choichiro
authors.initials: C
authors.lastname: Ozu
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Horiguchi
authors.forename: Kazunori
authors.initials: K
authors.lastname: Namiki
authors.forename: Masaaki
authors.initials: M
authors.lastname: Tachibana
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002278:Carcinoma in Situ / Q000473:pathology / Q000601:surgery*; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D059035:Perioperative Period; D011446:Prospective Studies; D012371:Robotics; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology* / Q000601:surgery*