LBA3 THE CHANGING FACE OF UROLOGIC ONCOLOGIC SURGERY FROM 2000-2018 (63 141 PATIENTS) - IMPACT OF ROBOTICS

Abstract

You have accessJournal of UrologyPlenary: Next Frontier1 Apr 2018LBA3 THE CHANGING FACE OF UROLOGIC ONCOLOGIC SURGERY FROM 2000-2018 (63 141 PATIENTS) - IMPACT OF ROBOTICS Inderbir Gill and Giovanni Cacciamani Inderbir GillInderbir Gill More articles by this author and Giovanni CacciamaniGiovanni Cacciamani More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.03.082AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Evaluate the status of urologic oncologic surgery, open versus robotic, over 17 years. METHODS Systematic review and meta-analysis of Pubmed, Scopus and Web of Science on surgery for localized prostate, bladder, kidney and testis cancer (01/2000-01/2018). Ultimately, we selected 3 highest-volume urologic oncologic surgeries, radical prostatectomy (RP), radical cystectomy (RC) and partial nephrectomy (PN). Principal robotic versus open comparative outcomes assessed: peri-operative, complications, functional, oncologic, survival, financial. Sensitivity analyses of baseline characteristics for each outcome was performed. Penetrance of robotic versus open surgery was determined (Premiere database). PROSPERO registration #CRD42017064958. RESULTS Of the 83 127 identified papers, 181 qualified for the study, comprising 63 141 unique surgical cases (36 158 open; 26 983 robotic). Overall effects estimate with 95% CI and assessment of risk bias and variability between studies (I2) for each of the evaluated 45 intervention groups is provided; total Forest plots n=2070. The Summary Forest plot (Figure) depicts select peri-operative, functional, oncologic and survival outcomes of robotic and open surgery. Robotic surgery had higher costs, primarily operative. In 2015, of all patients undergoing RP, RC and PN, robotics comprised 85.4%, 32.8% and 66.1%, respectively. Compared to 2005, these 2015 data indicate robotic surgery increased 4-fold for RP, 11-fold for RC and 110-fold for PN. In 2005, of the 105 300 prostate, bladder and kidney cancer surgeries, robotics comprised 29.6%; in 2015, this increased to 69.2% of the aggregate 88 198 surgeries CONCLUSIONS Robotics is now a major domain in uro-oncologic surgery vis-à-vis its open counterpart. Presented is the first meta-analysis of the entire field. Level I data are scarce. The world literature to date indicates that contemporary outcomes of robotic RP, RC and PN surgery are now at a minimum equal, but mostly superior, to open surgery, except for operative time and costs. Going forward, implementing metrics-based robotic training programs and assessing the financial value-proposition of robotics for the U.S. healthcare system is required. © 2018FiguresReferencesRelatedDetailsCited byCacciamani G, Desai M, Siemens D and Gill I (2022) Robotic Urologic Oncologic Surgery: Ever-Widening HorizonsJournal of Urology, VOL. 208, NO. 1, (8-9), Online publication date: 1-Jul-2022. Volume 199Issue 4SApril 2018Page: e577-e578 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Inderbir Gill More articles by this author Giovanni Cacciamani More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...