Robotic versus open radical cystectomy throughout the learning phase: insights from a real-life multicenter study
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Background and objectives
Robot-assisted radical cystectomy (RARC) has been shown to be non-inferior to open radical cystectomy (ORC) for the treatment of bladder cancer (BC). However, most data on RARC come from high-volume surgeons at high-volume centers. The objective of the study was to compare perioperative and mid-term oncologic outcomes of RARC versus ORC in a real-life cohort of patients treated by surgeons starting their experience with RARC.
Materials and methods
Data were prospectively collected from consecutive patients undergoing RARC and ORC at five referral Centers between 2010 and 2016 by five surgeons (one per center) with no prior experience in RARC. Patients with high-risk non-muscle-invasive or organ-confined muscle-invasive (T2N0M0) bladder cancer were considered for RARC. The main study endpoints were perioperative outcomes, postoperative surgical complications, and mid-term oncologic outcomes.
Overall, 124 and 118 patients underwent RARC and ORC, respectively. Baseline patients’ and tumors’ characteristics were comparable between the two groups. Yet, the proportion of patients receiving neoadjuvant chemotherapy was significantly higher in the RARC cohort. Median operative time was significantly higher, while median EBL, LOH, and transfusion rates were significantly lower after RARC. Median number of lymph nodes removed was significantly higher after RARC. All other histopathological outcomes, as well as the rate of early (< 30 days) and late postoperative complications, were comparable to ORC. At a median follow-up of 2 years, 29 (23%) and 41 (35%) patients developed disease recurrence (p = 0.05), while 20 (16%) and 37 (31%) died of bladder cancer (p = 0.005) after RARC and ORC, respectively.
With proper patient selection, RARC was non-inferior to ORC throughout the surgeons’ learning phase. Yet, the observed differences in oncologic outcomes suggest selection bias toward adoption of RARC for patients with more favorable disease characteristics.
KeywordsCystectomy Urinary bladder neoplasms Robotic surgical procedures Postoperative complications Comparative effectiveness research
LL: protocol/project development, data collection or management, data analysis, and manuscript writing/editing. RC: data analysis, and manuscript writing/editing. JP: protocol/project development. VG: data collection or management. AM-L: data collection or management. DV: data collection or management. ALT: protocol/project development. MR: protocol/project development. ML: data collection or management. LT: data collection or management. VM: data collection or management. BG: data analysis. GP: protocol/project development, and data collection or management. CV: protocol/project development. GV: protocol/project development, and manuscript writing/editing. MR: protocol/project development, and manuscript writing/editing.
Compliance with ethical standards
Conflict of interest
All authors declare that they have no conflict of interest.
Human and animal rights
Formal consent is not required for retrospective study.
Informed consent was obtained from all individual participants included in the study.