title: Perioperative and oncologic outcomes of robot-assisted vs. open radical cystectomy in bladder cancer patients: A comparison of two high-volume referral centers.
abstract: OBJECTIVE
  To examine perioperative and oncologic outcomes of open (ORC) and robot-assisted radical cystectomy (RARC) in bladder cancer (BCa) patients.
  
  
  METHODS
  368 consecutive patients with cT1-4 M0 BCa treated at two high-volume European centers between 2004 and 2013 were evaluated. Data on complications, operative time, blood loss, postoperative transfusion, reoperation, length of stay (LOS), positive margins, recurrence, cancer-specific mortality (CSM), and overall survival were evaluated. Uni- and multivariable regression analyses tested the impact of the surgical approach on perioperative and oncologic outcomes.
  
  
  RESULTS
  Overall, 230 (62.5%) and 138 (37.5%) patients were treated with ORC and RARC. In multivariable analyses RARC patients had higher odds of prolonged operative time and low-grade complications (all P ≤ 0.001). Patients treated with ORC had higher odds of blood loss >500 ml and prolonged LOS (all P ≤ 0.03). No differences were observed in high-grade complications and positive margins (all P ≥ 0.06). No differences were observed in 5-year recurrence-free and CSM-free survival rates between patients treated with ORC vs. RARC (57.1 vs. 54.2% and 61.9 vs. 73.5%; all P ≥ 0.3). This was confirmed in multivariable analyses, where the surgical approach was not associated with the risk of recurrence and CSM (all P ≥ 0.1).
  
  
  CONCLUSIONS
  Although ORC might be associated with a shorter operative time, RARC led to lower blood loss and shorter LOS. No differences exist in high-grade complications and positive margins. RARC and ORC provide similar oncologic control.
authors.affiliation: Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium; OLV Vattikuti Robotic Surgery Institute, Melle, Belgium; Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy. Electronic address: giorgio.gandaglia@gmail.com.
authors.forename: G
authors.initials: G
authors.lastname: Gandaglia
authors.affiliation: Department of Urology, LMU Munich, Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Karl
authors.affiliation: OLV Vattikuti Robotic Surgery Institute, Melle, Belgium; Department of Surgery, Oncology, and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Novara
authors.affiliation: Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.
authors.forename: R
authors.initials: R
authors.lastname: de Groote
authors.affiliation: Department of Urology, LMU Munich, Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Buchner
authors.affiliation: Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.
authors.forename: F
authors.initials: F
authors.lastname: D'Hondt
authors.affiliation: Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Montorsi
authors.affiliation: Department of Urology, LMU Munich, Munich, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Stief
authors.affiliation: Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium; OLV Vattikuti Robotic Surgery Institute, Melle, Belgium.
authors.forename: A
authors.initials: A
authors.lastname: Mottrie
authors.affiliation: Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium; Department of Urology, LMU Munich, Munich, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Gratzke
mesh_terms: D000368:Aged; D015653:Cystectomy / Q000379:methods*; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation; D065287:Robotic Surgical Procedures; D001749:Urinary Bladder Neoplasms / Q000401:mortality / Q000601:surgery*
keywords: Bladder cancer; Comparative effectiveness; Open; Radical cystectomy; Robot-assisted