title: Robotic versus open radical cystectomy: an updated systematic review and meta-analysis.
abstract: OBJECTIVE
  To critically review the currently available evidence of studies comparing robot-assisted radical cystectomy (RARC) with open radical cystectomy (ORC).
  
  
  METHODS
  A comprehensive review of the literature from Pubmed, Web of Science and Scopus was performed in April 2014. All relevant studies comparing RARC with ORC were included for further screening. A pooled meta-analysis of all comparative studies was performed and publication bias was assessed by a funnel plot.
  
  
  RESULTS
  Nineteen studies were included for the analysis, including a total of 1779 patients (787 patients in the RARC group and 992 patients in the ORC group). Although RARC was associated with longer operative time (p <0.0001), patients in this group might benefit from significantly lower overall perioperative complication rates within 30 days and 90 days (p = 0.005 and 0.0002, respectively), more lymph node yields (p = 0.009), less estimated blood loss (p <0.00001), lower need for perioperative and intraoperative transfusions (p <0.0001 and <0.0001, respectively), and shorter postoperative length of stay (p = 0.0002). There was no difference between two groups regarding positive surgical margin rates (p = 0.19).
  
  
  CONCLUSIONS
  RARC appears to be an efficient alternative to ORC with advantages of less perioperative complications, more lymph node yields, less estimated blood loss, lower need for transfusions, and shorter postoperative length of stay. Further studies should be performed to compare the long-term oncologic outcomes between RARC and ORC.
authors.affiliation: Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China.
authors.forename: Leilei
authors.initials: L
authors.lastname: Xia
authors.affiliation: Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China.
authors.forename: Xianjin
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China.
authors.forename: Tianyuan
authors.initials: T
authors.lastname: Xu
authors.affiliation: Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China.
authors.forename: Xiaohua
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China.
authors.forename: Zhaowei
authors.initials: Z
authors.lastname: Zhu
authors.affiliation: Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China.
authors.forename: Liang
authors.initials: L
authors.lastname: Qin
authors.affiliation: Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China.
authors.forename: Xiang
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China.
authors.forename: Chen
authors.initials: C
authors.lastname: Fang
authors.affiliation: Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China.
authors.forename: Minguang
authors.initials: M
authors.lastname: Zhang
authors.affiliation: Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China.
authors.forename: Shan
authors.initials: S
authors.lastname: Zhong
authors.affiliation: Department of Urology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, P. R. China.
authors.forename: Zhoujun
authors.initials: Z
authors.lastname: Shen
mesh_terms: D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012371:Robotics
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