Open vs Robotic Radical Cystectomy Outcomes at a Single Institution: A Retrospective Review of 152 Patients

Abstract

Introduction: Robotic radical cystectomy is becoming increasingly used over the traditional open approach; however, the potential advantages remain an area of active investigation, with several studies to date finding overall comparable outcomes. We sought to add to the existing body of work by performing a retrospective review of open vs robotic radical cystectomies performed at our institution. Methods: All patients who underwent radical cystectomy for urothelial cancer with curative intent at New York University (Manhattan and Long Island sites) were included. Surgical dates spanned between October 2017 and March 2022. Individual patient charts were reviewed in Epic for data extraction. Results: A total of 152 patients were included in the final analysis including 71 robotic and 81 open radical cystectomies. Estimated blood loss and the number of perioperative blood transfusions were significantly lower in the robotic cohort, whereas operative times were significantly longer. The median length of stay was 5 days in the robotic cohort vs 6 days in the open cohort; this only reached statistical significance for the ileal conduit subgroup. However, 90-day mortality, return to emergency department, readmissions, and complication rates were not significantly different. Oncologic outcomes were also similar, aside from an increase in lymph node count among the robotic cohort. Conclusions: In the hands of experienced surgeons, a robotic surgical approach did not confer major benefits in perioperative morbidity and mortality, although it did achieve similar oncologic efficacy, led to fewer blood transfusions, and led to a shorter length of stay in patients who underwent ileal conduits diversions.