Comparative Effectiveness of Robot-assisted Radical Cystectomy with Intracorporeal Urinary Diversion Vs Open Radical Cystectomy for Bladder Cancer

Overview

Journal BJU Int

Specialty Urology

Date 2024 Oct 21

PMID 39433445

Authors

Pierre-Etienne Gabriel

Ugo Pinar

Louis Lenfant

Jerome Parra

Christophe Vaessen

Pierre Mozer

Emmanuel Chartier-Kastler

Morgan Roupret

Thomas Seisen

Affiliations

Soon will be listed here.

Abstract

Objectives: To assess the comparative effectiveness of robot-assisted radical cystectomy (RARC) with intracorporeal urinary diversion (ICUD) vs open radical cystectomy (ORC) for bladder cancer (BC).

Patients And Methods: We conducted a real-life monocentric study including all consecutive patients who underwent RARC with ICUD or ORC for BC at our institution from 2014 to 2023. Uni- and multivariable logistic and Cox regression analyses were used to compare perioperative, oncological and stricture outcomes between both groups by calculating odds (ORs) and hazard (HRs) ratios with their corresponding 95% confidence intervals (CIs), respectively.

Results: Overall, 316 patients underwent either RARC with ICUD (n = 228 [72.2%]) or ORC (n = 88 [27.8%]). The perioperative benefits of RARC vs ORC included decreased risks of major blood loss (OR 0.10, 95% CI 0.04-0.23; P < 0.001), perioperative transfusion (OR 0.30, 95% CI 0.16-0.57; P < 0.001), 90-day major complications (OR 0.56, 95% CI 0.29-0.99; P = 0.04), and prolonged initial length of hospital stay (OR 0.20, 95% CI 0.09-0.35; P < 0.001), as well as more days alive and out of the hospital within 90 days of surgery (OR 2.56, 95% CI 1.46-4.6; P < 0.01). In addition, the use of RARC vs ORC was associated with a higher lymph node (LN) count (OR 3.35, 95% CI 1.83-6.30; P < 0.001), while there was no significant difference in recurrence-free (HR 0.72, 95% CI 0.49-1.07; P = 0.1), cancer-specific (HR 0.69, 95% CI 0.43-1.10; P = 0.1), overall (HR 0.76, 95% CI 0.47-1.20; P = 0.3) and uretero-ileal stricture-free (HR 1.18, 95% CI 0.62-2.25; P = 0.6) survival between both groups after a median (interquartile range) follow-up of 42.3 (16.4-73.8) months.

Conclusion: Our real-world study supports the effectiveness of RARC with ICUD vs ORC for BC. We generally observed better perioperative outcomes, as well as similar oncological-except for higher LN count-and uretero-ileal stricture outcomes after RARC with ICUD vs ORC.

References

Yuh B, Wilson T, Bochner B, Chan K, Palou J, Stenzl A . Systematic review and cumulative analysis of oncologic and functional outcomes after robot-assisted radical cystectomy. Eur Urol. 2015; 67(3):402-22. DOI: 10.1016/j.eururo.2014.12.008. View

Parekh D, Messer J, FitzGerald J, Ercole B, Svatek R . Perioperative outcomes and oncologic efficacy from a pilot prospective randomized clinical trial of open versus robotic assisted radical cystectomy. J Urol. 2012; 189(2):474-9. DOI: 10.1016/j.juro.2012.09.077. View

Fu S, Shi H, Fan Z, Li J, Luan T, Dong H . Robot-assisted radical cystectomy with intracorporeal urinary diversion: an updated systematic review and meta-analysis of its differential effect on effectiveness and safety. Int J Surg. 2024; 110(4):2366-2380. PMC: 11020008. DOI: 10.1097/JS9.0000000000001065. View

Witjes J, Bruins H, Carrion A, Cathomas R, Comperat E, Efstathiou J . European Association of Urology Guidelines on Muscle-invasive and Metastatic Bladder Cancer: Summary of the 2023 Guidelines. Eur Urol. 2023; 85(1):17-31. DOI: 10.1016/j.eururo.2023.08.016. View

Bochner B, Dalbagni G, Sjoberg D, Silberstein J, Paz G, Donat S . Comparing Open Radical Cystectomy and Robot-assisted Laparoscopic Radical Cystectomy: A Randomized Clinical Trial. Eur Urol. 2014; 67(6):1042-1050. PMC: 4424172. DOI: 10.1016/j.eururo.2014.11.043. View

Zeuschner P, Linxweiler J, Mohr R, van Heemskerk S, Wagenpfeil G, Wagenpfeil S . Robot-assisted versus open radical cystectomy: A cohort study on perioperative outcomes accounting for stage selection bias and surgical experience. Int J Med Robot. 2021; 17(4):e2258. DOI: 10.1002/rcs.2258. View

Vejlgaard M, Maibom S, Joensen U, Thind P, Rohrsted M, Aasvang E . Quality of life and secondary outcomes for open versus robot-assisted radical cystectomy: a double-blinded, randomised feasibility trial. World J Urol. 2022; 40(7):1669-1677. DOI: 10.1007/s00345-022-04029-9. View

Mortezavi A, Crippa A, Kotopouli M, Akre O, Wiklund P, Hosseini A . Association of Open vs Robot-Assisted Radical Cystectomy With Mortality and Perioperative Outcomes Among Patients With Bladder Cancer in Sweden. JAMA Netw Open. 2022; 5(4):e228959. PMC: 9051984. DOI: 10.1001/jamanetworkopen.2022.8959. View

Bochner B, Dalbagni G, Marzouk K, Sjoberg D, Lee J, Donat S . Randomized Trial Comparing Open Radical Cystectomy and Robot-assisted Laparoscopic Radical Cystectomy: Oncologic Outcomes. Eur Urol. 2018; 74(4):465-471. PMC: 6697266. DOI: 10.1016/j.eururo.2018.04.030. View

10.

Catto J, Khetrapal P, Ricciardi F, Ambler G, Williams N, Al-Hammouri T . Effect of Robot-Assisted Radical Cystectomy With Intracorporeal Urinary Diversion vs Open Radical Cystectomy on 90-Day Morbidity and Mortality Among Patients With Bladder Cancer: A Randomized Clinical Trial. JAMA. 2022; 327(21):2092-2103. PMC: 9109000. DOI: 10.1001/jama.2022.7393. View

11.

McNicholas D, El-Taji O, Siddiqui Z, Hanchanale V . Systematic review comparing uretero-enteric stricture rates between open cystectomy with ileal conduit, robotic cystectomy with extra-corporeal ileal conduit and robotic cystectomy with intra corporeal ileal conduit formation. J Robot Surg. 2024; 18(1):100. PMC: 10899269. DOI: 10.1007/s11701-024-01850-9. View

12.

Khetrapal P, Wong J, Tan W, Rupasinghe T, Tan W, Williams S . Robot-assisted Radical Cystectomy Versus Open Radical Cystectomy: A Systematic Review and Meta-analysis of Perioperative, Oncological, and Quality of Life Outcomes Using Randomized Controlled Trials. Eur Urol. 2023; 84(4):393-405. DOI: 10.1016/j.eururo.2023.04.004. View

13.

Zhang J, Ericson K, Thomas L, Knorr J, Khanna A, Crane A . Large Single Institution Comparison of Perioperative Outcomes and Complications of Open Radical Cystectomy, Intracorporeal Robot-Assisted Radical Cystectomy and Robotic Extracorporeal Approach. J Urol. 2019; 203(3):512-521. DOI: 10.1097/JU.0000000000000570. View

14.

Venkatramani V, Reis I, Castle E, Gonzalgo M, Woods M, Svatek R . Predictors of Recurrence, and Progression-Free and Overall Survival following Open versus Robotic Radical Cystectomy: Analysis from the RAZOR Trial with a 3-Year Followup. J Urol. 2019; 203(3):522-529. PMC: 7487279. DOI: 10.1097/JU.0000000000000565. View

15.

Parekh D, Reis I, Castle E, Gonzalgo M, Woods M, Svatek R . Robot-assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer (RAZOR): an open-label, randomised, phase 3, non-inferiority trial. Lancet. 2018; 391(10139):2525-2536. DOI: 10.1016/S0140-6736(18)30996-6. View

16.

Vetterlein M, Klemm J, Gild P, Bradtke M, Soave A, Dahlem R . Improving Estimates of Perioperative Morbidity After Radical Cystectomy Using the European Association of Urology Quality Criteria for Standardized Reporting and Introducing the Comprehensive Complication Index. Eur Urol. 2019; 77(1):55-65. DOI: 10.1016/j.eururo.2019.08.011. View

17.

Messer J, Punnen S, FitzGerald J, Svatek R, Parekh D . Health-related quality of life from a prospective randomised clinical trial of robot-assisted laparoscopic vs open radical cystectomy. BJU Int. 2014; 114(6):896-902. DOI: 10.1111/bju.12818. View

18.

Stein J, Lieskovsky G, Cote R, Groshen S, Feng A, Boyd S . Radical cystectomy in the treatment of invasive bladder cancer: long-term results in 1,054 patients. J Clin Oncol. 2001; 19(3):666-75. DOI: 10.1200/JCO.2001.19.3.666. View

19.

Leow J, Reese S, Jiang W, Lipsitz S, Bellmunt J, Trinh Q . Propensity-matched comparison of morbidity and costs of open and robot-assisted radical cystectomies: a contemporary population-based analysis in the United States. Eur Urol. 2014; 66(3):569-76. DOI: 10.1016/j.eururo.2014.01.029. View

20.

Novara G, Catto J, Wilson T, Annerstedt M, Chan K, Murphy D . Systematic review and cumulative analysis of perioperative outcomes and complications after robot-assisted radical cystectomy. Eur Urol. 2015; 67(3):376-401. DOI: 10.1016/j.eururo.2014.12.007. View