title: Perioperative complications and oncological safety of robot-assisted (RARC) vs. open radical cystectomy (ORC).
abstract: OBJECTIVE
  To assess the surgical and oncological outcome of robot-assisted radical cystectomy (RARC) compared with open radical cystectomy (ORC).
  
  
  METHODS
  Clinical data of 64 patients undergoing RARC between August 2010 and August 2013 were prospectively documented and retrospectively compared with 79 patients undergoing ORC between August 2008 and August 2013 at a single academic institution. Perioperative results, surgical margins status, and nodal yield after RARC and ORC were compared using Mann-Whitney U test (continuous variables) and chi-square test (categorical variables). Additional age-stratified analysis was performed in elderly patients (≥75 y). To avoid inference errors by multiple testing, P-values were adjusted using Bonferroni׳s correction.
  
  
  RESULTS
  Baseline characteristics of both cohorts were balanced. RARC patients had significantly less blood loss (RARC: 300 [interquartile range {IQR}: 200-500]ml; perioperative transfusion rate: 0 [IQR: 0-2] red packed blood cells [RPBCs]; ORC: 800 [IQR: 500-1200]ml, P<0.01; transfusion rate: 3 [IQR: 2-4] RPBCs, P<0.01), and hospital stay of RARC patients was reduced by 20% (RARC: 13 [IQR: 9-17]d, ORC: 16 [IQR: 13-21]d, P< 0.01). A total of 55 patients who underwent RARC and 59 patients who underwent ORC were eligible for analysis of oncological surrogates "surgical margin status" and "lymph-node yield" as well as for survival data. No differences between patients undergoing RARC or ORC were observed. In elderly patients (≥75 y; RARC: 17 patients, ORC: 28 patients), decreased intraoperative blood loss (RARC: 300 [IQR: 100-475]ml; ORC: 800 [IQR: 400-1300]ml, P<0.01) and lower transfusion rate (RARC: 0 [IQR: 0-1] RPBCs; ORC: 4 [IQR: 2-5] RPBCs, P<0.01) were observed in the robotic group. Major limitations of this study are the retrospective study design and a potential selection bias.
  
  
  CONCLUSIONS
  RARC provides significant advantages compared with ORC regarding blood loss and postoperative recovery, whereas surgical and oncological outcomes are not different.
authors.affiliation: Department of Urology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany. Electronic address: Guenter.Niegisch@med.uni-duesseldorf.de.
authors.forename: Günter
authors.initials: G
authors.lastname: Niegisch
authors.affiliation: Department of Urology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Albers
authors.affiliation: Department of Urology, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Rabenalt
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D015653:Cystectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology* / Q000209:etiology; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000009:adverse effects*; D001749:Urinary Bladder Neoplasms / Q000601:surgery*
keywords: Bladder cancer; Radical cystectomy; Robot-assisted laparoscopic cystectomy; Robotic cystectomy; Surgical quality