Robotic-Assisted Radical Cystectomy Outcomes

Abstract

AbstractOutcome assessment of radical cystectomy and subsequent urinary diversion can be subdivided into perioperative outcome including, quality of life, erectile function and continence (in case of orthotopic bladder substitution), and oncological outcome. Five randomized clinical trials with a total of 541 patients have assessed some of these parameters prospectively and compared them between robot-assisted radical cystectomy (RARC) with extracorporeal urinary diversion (ECUD) and open radical cystectomy (ORC). Results from a limited number of large (>100 patients) retrospective cohort studies and one prospective not randomized comparative effectiveness trial comparing RARC with intracorporeal urinary diversion (ICUD) and ORC have recently been reported.The mean estimated blood loss, transfusion rate, and hospital length of stay favors RARC while the operation time is shorter for ORC. In terms of perioperative parameters, ICUD appear to have further advantages compared to ECUD. Rates for any complication and high-grade (Clavien-Dindo III-V) events are similar for the open and robotic approach, although a trend toward less frequent high-grade complications for RARC with ICUD compared to ORC have been observed, once the initial learning curve has been overcome.No difference in quality of life have been detected in prospective trials comparing RARC with ECUD and ORC by patient-reported outcome. Conflicting results regarding a superior outcome exists when it comes to RARC with ICUD. Functional outcome data for intracorporeal orthotopic bladder substitution is limited; reported results implicate a comparable or slightly inferior continence compared to an open approach.The current evidence for long-term outcomes following RARC with ECUD shows acceptable oncological outcomes comparable to open series including recurrence-free survival data, positive surgical margin rates, and lymph node yields. However, evidence for RARC with ICUD is limited with one study indicating a slightly better overall-survival rate compared with ORC.KeywordsRobot-assisted radical cystectomyExtracorporeal urinary diversionIntracorporeal urinary diversionPerioperative outcomeComplication rateFunctional outcomeOncological outcome