title: Systematic review and cumulative analysis of perioperative outcomes and complications after robot-assisted radical cystectomy.
abstract: BACKGROUND
  Although open radical cystectomy (ORC) is still the standard approach, laparoscopic radical cystectomy (LRC) and robot-assisted radical cystectomy (RARC) have gained popularity.
  
  
  OBJECTIVE
  To report a systematic literature review and cumulative analysis of perioperative outcomes and complications of RARC in comparison with ORC and LRC.
  
  
  METHODS
  Medline, Scopus, and Web of Science databases were searched using a free-text protocol including the terms robot-assisted radical cystectomy or da Vinci radical cystectomy or robot* radical cystectomy. RARC case series and studies comparing RARC with either ORC or LRC were collected. Cumulative analysis was conducted.
  
  
  RESULTS
  The searches retrieved 105 papers. According to the different diversion type, overall mean operative time ranged from 360 to 420 min. Similarly, mean blood loss ranged from 260 to 480 ml. Mean in-hospital stay was about 9 d for all diversion types, with consistently high readmission rates. In series reporting on RARC with either extracorporeal or intracorporeal conduit diversion, overall 90-d complication rates were 59% (high-grade complication: 15%). In series reporting RARC with intracorporeal continent diversion, the overall 30-d complication rate was 45.7% (high-grade complication: 28%). Reported mortality rates were ≤3% for all diversion types. Comparing RARC and ORC, cumulative analyses demonstrated shorter operative time for ORC, whereas blood loss and in-hospital stay were better with RARC (all p values <0.003). Moreover, 90-d complication rates of any-grade and 90-d grade 3 complication rates were lower for RARC (all p values <0.04), whereas high-grade complication and mortality rates were similar.
  
  
  CONCLUSIONS
  RARC can be performed safely with acceptable perioperative outcome, although complications are common. Cumulative analyses demonstrated that operative time was shorter with ORC, whereas RARC may provide some advantages in terms of blood loss and transfusion rates and, more limitedly, for postoperative complication rates over ORC and LRC.
  
  
  RESULTS
  Although open radical cystectomy (RC) is still regarded as a standard treatment for muscle-invasive bladder cancer, laparoscopic and robot-assisted RC are becoming more popular. Robotic RC can be safely performed with acceptably low risk of blood loss, transfusion, and intraoperative complications; however, as for open RC, the risk of postoperative complications is high, including a substantial risk of major complication and reoperation.
authors.affiliation: Department of Surgery, Oncology, and Gastroenterology - Urology Clinic, University of Padua, Italy. Electronic address: giacomonovara@gmail.com.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Novara
authors.affiliation: Academic Urology Unit, University of Sheffield, Sheffield, UK.
authors.forename: James W F
authors.initials: JW
authors.lastname: Catto
authors.affiliation: City of Hope National Cancer Center Duarte, CA, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Wilson
authors.affiliation: Department of Urology, Herlev University Hospital, Denmark.
authors.forename: Magnus
authors.initials: M
authors.lastname: Annerstedt
authors.affiliation: City of Hope National Cancer Center Duarte, CA, USA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Chan
authors.affiliation: Division of Cancer Surgery, Peter MacCallum Cancer Centre, St. Andrews Place, East Melbourne, Victoria, Australia.
authors.forename: Declan G
authors.initials: DG
authors.lastname: Murphy
authors.affiliation: Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.
authors.forename: Alexander
authors.initials: A
authors.lastname: Motttrie
authors.affiliation: Vattikuti Urology Institute, Henry Ford Health System, Detroit, MI, USA.
authors.forename: James O
authors.initials: JO
authors.lastname: Peabody
authors.affiliation: Department of Urology, Stanford University, Stanford, CA, USA.
authors.forename: Eila C
authors.initials: EC
authors.lastname: Skinner
authors.affiliation: Karolinska University Hospital, Urology, Stockholm, Sweden.
authors.forename: Peter N
authors.initials: PN
authors.lastname: Wiklund
authors.affiliation: Department of Urology, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Khurshid A
authors.initials: KA
authors.lastname: Guru
authors.affiliation: City of Hope National Cancer Center Duarte, CA, USA.
authors.forename: Bertram
authors.initials: B
authors.lastname: Yuh
mesh_terms: D016063:Blood Loss, Surgical; D016009:Chi-Square Distribution; D015653:Cystectomy / Q000009:adverse effects* / Q000401:mortality; D006801:Humans; D007902:Length of Stay; D016017:Odds Ratio; D061646:Operative Time; D010359:Patient Readmission; D011183:Postoperative Complications / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D012307:Risk Factors; D065287:Robotic Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*
keywords: Laparoscopic radical cystectomy; Radical cystectomy; Robotic radical cystectomy; Robotics