Robotic versus open radical cystectomy: identification of patients who benefit from the robotic approach.
OBJECTIVE
To identify patients who would benefit from robot-assisted radical cystectomy (RARC), we report perioperative outcomes and complications.


METHODS
We compared patients who underwent RARC to patients who underwent open cystectomy (OC) in our institution. Data included demographics, operative variables, and recovery. Complications were grouped into early (<30 days), intermediate (31-90 days), and late (>90 days).


RESULTS
There were 58 patients in the RARC group and 84 patients in the OC group. The mean age was 66 ± 1.2 years in the RARC v 67 ± 1.2 in OC (p=0.53) group. Women constituted 21% in the RARC and 30% in OC (p=0.23) group. The mean American Society of Anesthesiologists scores were 2.9 for the RARC and 2.94 for OC (p=0.5). The mean operative time for RARC was 7.8 ± 1.5 hours v 6.6 ± 1.25 hours for OC (p<0.0001). Estimated blood loss was 276 ± 48 mL in RARC v 1522 ± 369 mL in OC (p<0.0001). Positive margin rate was 7% in RARC v 8% in OC (p=0.8). Early complications of any severity (Clavien scores) occurred in 43% in RARC and 64% in OC (p=0.02). There was one mortality in RARC and two mortalities in OC. Patients were grouped by age (≥ 70- and <70-years old). The older group consisted of 19 and 44 patients in RARC and OC, respectively. Both age groups in RARC had less early complications than OC patients (p<0.014). The older group in RARC had less early complication rate (17%) than the younger group in OC (59%).


CONCLUSIONS
RARC has improved perioperative outcomes with equivalent oncological parameters when compared to open cystectomy. Patients ≥ 70-years old benefit from the robotic approach, particularly when compared to younger patients undergoing open cystectomy.
Division of Urology, Department of Surgery, University of Alabama-Birmingham, Birmingham, Alabama 35294, USA.
Michael L
ML
Knox
Rizk
R
El-Galley
Joseph E
JE
Busby
D000368:Aged; D015653:Cystectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy / Q000379:methods*; D007902:Length of Stay / Q000639:trends; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012371:Robotics; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery; D001749:Urinary Bladder Neoplasms / Q000601:surgery*; D014547:Urinary Diversion / Q000379:methods*