Abstract
Abstract Background and Objective: The second most prevalent genitourinary cancer and the fourth most frequent cancer overall in the US is bladder cancer (BCa). The majority of patients (70%) have non-muscle-invasive BCa (NMIBC), which has a 50%–70% recurrence rate and may proceed to 10%–20% of cases to muscle-invasive BCa (MIBC). The ultimate prognosis of patients with MIBC and NMIBC is mostly influenced by surgical therapy. Although radical cystectomy (RC) has undergone numerous modifications to optimise patient outcomes in terms of cost-effectiveness, cancer control and post-operative complications, it is still a morbid procedure with a variable rate of complications. Despite this, RC is still regarded as the gold standard of care. Robot-assisted RC (RARC) is becoming more and more evidence-based, and this has made it possible to make some first judgements on how successful RARC is in comparison to open RC (ORC). This systematic review and meta-analysis aim to provide a comprehensive overview highlighting the results of RARC comparison with ORC. Methods: Four electronic databases, PubMed, Scopus, Cochrane Library and Web of Science were searched for relevant studies until 20 April 2024. These outcomes operative time (min), blood loss, length of stay (days) and recurrence rate were assessed. Analysis was performed using R Studio software. The data extracted were in dichotomous and continuous forms and were entered as an event and a total for the risk ratio (RR) and mean and standard deviation for mean difference (MD) between the RARC and ORC groups, along with their corresponding 95% confidence intervals (CIs) using a random model. Results: Eight studies were systematically reviewed and included in the meta-analysis, involving 2566 patients. Of them, 971 were drug-resistant, and 1595 were drug-sensitive. Our analysis revealed that ORC was better regarding operative time; MD was 56.28 (95% CI 33.31; 79.24, P < 0.01), while RARC was associated with lower blood loss; MD was − 203.00 (−310.03; −95.9, P < 0.001). According to the length of hospital stay and recurrence rate, none of them was superior to the other; MD was − 0.43 (95% CI − 1.70; 0.84, P = 0.5); RR was 0.99 (95% CI 0.75; 1.30, P = 0.93). Conclusion: Our comprehensive research found that RARC is not inferior to ORC. In addition to highlighting the significance of evidence-based decision-making in urological practice, our results provide helpful information to both doctors and patients as they navigate BCa therapy choices. This finding is considered a cornerstone for refining new surgical techniques.
Published Version
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