Comparison of perioperative and oncologic outcomes between robot-assisted and laparoscopic radical cystectomy for bladder cancer: a systematic review and updated meta-analysis.

Abstract

Currently, there is limited evidence comparing robot-assisted radical cystectomy (RARC) to laparoscopic radical cystectomy (LRC). The purpose of this study is to systematically review the literature and conduct a meta-analysis. We conducted a systematic literature search to identify matching publications regarding RARC and LRC for bladder cancer through PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science with no restriction to date and language. The evaluated outcomes include perioperative outcomes (i.e. days to oral intake, operative time, estimated blood loss (EBL), transfusion rates, length of stay (LOS) and complication rates) and oncological outcomes (i.e. positive surgical margin (PSM), lymph node yield, and overall survival (OS)). After screening 780 articles, 10 studies were included in the final meta-analysis. We found that there was no significant difference with regard to basic demographic variables, operative time, and PSM. There were statistically significant shorter LOS (MD - 0.63, 95% CI - 1.24, 0.03), fewer complication rates (the risk ratios were 0.74 and 0.49 for Clavien grade 1-2 and Clavien grade 3-5,respectively), more lymph node yield (MD 2.38, 95% CI 1.89-2.87) and less death risk (HR 0.26, 95% CI 0.17-0.39) in RARC group compared with LRC group. Our findings indicated that patients with RARC may benefit from significantly lower complications, shorter LOS, higher lymph node yield and lower death risk. These data thus showed that RARC might improve the management of patients with muscle invasive or high-risk non-muscle invasive bladder cancer.