Open versus robotic cystectomy: Comparison of outcomes.
Open radical cystectomy (ORC) is the current gold standard treatment for muscle invasive bladder cancer. As surgeons become more proficient in minimally invasive and robotic surgical techniques, the number of patients undergoing robotic-assisted radical cystectomy (RARC) is increasing. Although minimally invasive methods are on the rise, research that critically compares open surgery with robotic methods is limited. In this review, we surveyed and appraised the current literature comparing ORC and RARC with regards to perioperative, functional, and oncologic outcomes in order to distinguish the benefits and disadvantages of each method. Here we report that RARC is associated with several perioperative advantages over ORC such as lower estimated blood loss and transfusion rate, and possibly faster gastrointestinal recovery, lower narcotic requirement, and shorter length of stay. ORC is less costly and permits less time in the operating room. Recent data suggests that there is no difference between ORC and RARC when comparing urinary continence and postoperative quality of life. Moreover, ORC and RARC are both associated with similar rates of obtaining positive surgical margins, lymph node yield, and recurrence. However, RARC patients had an increased likelihood of having distant metastases to extrapelvic lymph nodes and the peritoneum. At this point, it is unclear if ORC or RARC has superior patient outcomes, and more research is needed to ascertain management-altering conclusions.
Division of Urology, Department of Surgery, Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Rachel B
RB
Davis
Division of Urology, Department of Surgery, Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Nicholas J
NJ
Farber
Division of Urology, Department of Surgery, Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
Alexandra L
AL
Tabakin
Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
Isaac Y
IY
Kim
Division of Urology, Department of Surgery, Rutgers - Robert Wood Johnson Medical School, New Brunswick, NJ, USA.; Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
Sammy E
SE
Elsamra
D016063:Blood Loss, Surgical; D015653:Cystectomy / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D061646:Operative Time; D011788:Quality of Life; D065287:Robotic Surgical Procedures / Q000009:adverse effects / Q000191:economics / Q000379:methods*; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000191:economics / Q000601:surgery*; D014554:Urination
Cystectomy; Outcome assessment; Robotic surgical procedures; Urinary bladder neoplasms; Urinary diversion