Abstract
BackgroundRadical cystectomy is associated with high rates of perioperative morbidity. Robotic-assisted radical cystectomy (RARC) is widely used today despite limited evidence for clinical superiority. The aim of this review was to evaluate the effect of RARC compared to open radical cystectomy (ORC) on complications and secondary on length of stay, time back to work and health-related quality of life (HRQoL).MethodsThe databases PubMed, The Cochrane Library, Embase and CINAHL were searched. A systematic review according to the PRISMA guidelines and cumulative analysis was conducted. Randomized controlled trials (RCTs) that examined RARC compared to ORC were included in this review. We assessed the quality of evidence using the Cochrane Collaboration’s ‘Risk of bias’ tool and Grading of Recommendations Assessment, Development and Evaluation approach. Data were extracted and analysed.ResultsThe search retrieved 273 articles. Four RCTs were included involving overall 239 patients. The quality of the evidence was of low to moderate quality. There was no significant difference between RARC and ORC in the number of patients developing complications within 30 or 90 days postoperatively or in overall grade 3–5 complications within 30 or 90 days postoperatively. Types of complications differed between the RARC and the ORC group. Likewise, length of stay and HRQoL at 3 and 6 months did not differ.ConclusionOur review presents evidence for RARC not being superior to ORC regarding complications, LOS and HRQoL. High-quality studies with consistent registration of complications and patient-related outcomes are warranted.Systematic review registrationPROSPERO CRD42016038232
Highlights
Radical cystectomy is associated with high rates of perioperative morbidity
Assessment of reporting of complications To assess the quality of reporting of complications after urologic procedures using the Clavien-Dindo classification, we used the data extraction form from the European Association of Urology guideline “Reporting and Grading of Complications after Urologic Surgical Procedures” [19]
We found no differences between the robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC) groups in complications, length of stay (LOS) and health-related quality of life (HRQoL) at 3 or 6 months
Summary
Radical cystectomy is associated with high rates of perioperative morbidity. Robotic-assisted radical cystectomy (RARC) is widely used today despite limited evidence for clinical superiority. The aim of this review was to evaluate the effect of RARC compared to open radical cystectomy (ORC) on complications and secondary on length of stay, time back to work and health-related quality of life (HRQoL). Bladder cancer is the ninth most common cancer with an estimated 429,800 new cases and 165,100 deaths in 2012. Radical cystectomy is the standard treatment for patients with muscle-invasive bladder cancer and in selected patients with non-muscle-invasive bladder cancer [1]. Patients undergoing radical cystectomy are at high risk of perioperative morbidity with about 60% experiencing at least one complication within 90 days after surgery [3, 4]. In 2003, robot-assisted radical cystectomy (RARC) was introduced [6] and from 2004 to 2010, the utilization of RARC has increased from
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