University of Hertfordshire

From the same journal

By the same authors

  • Pramit Khetrapal
  • Joanna Kae Ling Wong
  • Wei Phin Tan
  • Thiara Rupasinghe
  • Wei Shen Tan
  • Stephen Williams
  • Stephen A. Boorjian
  • Carl Wijburg
  • Dipen J. Parekh
  • Peter Wiklund
  • Nikhil Vasdev
  • Muhammad Shamim Khan
  • Khurshid A Guru
  • James W.F. Catto
  • John D Kelly
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Original languageEnglish
JournalEuropean Urology
Publication statusSubmitted - 21 Sep 2022

Abstract

Context
Differences in recovery, oncological and quality of life outcomes between open radical cystectomy (ORC) and robot-assisted radical cystectomy (RARC) for patients with bladder cancer are unclear.
Objective
To compare these outcomes within randomized trials of ORC and RARC in this context. Primary outcome was the rate of 90-day perioperative events. Secondary outcomes included operative, pathological, survival and health related quality of life (HRQoL) measures.Evidence Acquisition
Systematic literature searches of MEDLINE, Embase, Web of Science and clinicaltrials.gov were performed up to 31st May 2022.
Evidence Synthesis
Eight trials, reporting 1,024 participants, were included. RARC was associated with shorter hospital length of stay (LOS; mean difference [MD] 0.21, 95% confidence interval [CI] 0.03- 0.39, p=0.02) and similar complication rates compared to ORC. ORC was associated with higher thromboembolic events (odds ratio [OR] 1.84, 95% CI 1.02-3.31, p=0.04). ORC was associated with more blood loss (MD 322 ml, 95% CI 193-450, p<0.001) and transfusions (OR 2.35, 95% CI 1.65-3.36, p<0.001), but shorter operative time (MD 75.71 minutes, 95% CI 39.34-112.08, p<0.001) compared with RARC. No differences in lymph node yield (MD 1.07, 95% CI -1.73-3.86, p=0.45) or positive surgical margin rates (OR 0.95, 95% CI 0.54-
5 1.67, p=0.87) were present. RARC was associated with better physical functioning or wellbeing (standardized MD [SMD] 0.47, 95% CI 0.29-0.65, p<0.001) and role functioning (MD 8.79, 95% CI 2.43-15.14, p=0.007) domains, but no improvement in overall HRQoL. No difference in progression-free survival (PFS) or overall survival (OS) were seen. Limitations may include lack of generalization given trial patients and design may not reflect real-world evidence in addition to centers of excellence assessed in current study.
Conclusions
RARC offers various peri-operative benefits over ORC. It might be more suitable in patients wishing to avoid blood transfusion, wanting a shorter LOS or those at high risk of thromboembolic events. Patient summary
This study compares robot-assisted keyhole surgery with open surgery for bladder cancer. The robot-assisted approach offered less blood loss, shorter hospital stays and fewer blood clots. No other differences were seen.

ID: 31813010