Robot‐assisted vs open radical cystectomy for bladder cancer in adults

Background It has been suggested that, in comparison with open radical cystectomy (ORC), robot‐assisted radical cystectomy (RARC) results in less blood loss, shorter convalescence and fewer complications, with equivalent short‐term oncological and functional outcomes; however, uncertainty remains as to the magnitude of these benefits. Objectives To assess the effects of RARC vs ORC in adults with bladder cancer. Search Methods We conducted a comprehensive search, with no restrictions on language of publication or publication status, for randomized controlled trials (RCTs) that compared RARC with ORC. The date of the last search was 1 July 2018. Databases searched included the Cochrane Central Register of Controlled Trials, MEDLINE (1999 to July 2018), PubMed Embase (1999 to July 2018), Web of Science (1999 to July 2018), Cancer Research UK (www.cancerresearchuk.org/), and the Institute of Cancer Research (www.icr.ac.uk/). We also searched the following trial registers: ClinicalTrials.gov (clinicaltrials.gov/); BioMed Central International Standard Randomized Controlled Trials Number (ISRCTN) Registry (www.isrctn.com); and the World Health Organization International Clinical Trials Registry Platform. The review was based on a published protocol. Primary outcomes of the review were recurrence‐free survival and major postoperative complications (Clavien grade III to V). Secondary outcomes were minor postoperative complications (Clavien grades I and II), transfusion requirement, length of hospital stay (days), quality of life, and positive surgical margins (%). Three review authors independently assessed relevant titles and s of records identified by the literature search to determine which studies should be assessed further. Two review authors assessed risk of bias using the Cochrane risk‐of‐bias tool and rated the quality of evidence according to GRADE. We used Review Manager 5 to analyse the data. Results We included in the review five RCTs comprising a total of 541 participants. Total numbers of participants included in the ORC and RARC cohorts were 270 and 271, respectively. We found that RARC and ORC may result in a similar time to recurrence (hazard ratio 1.05, 95% confidence interval [CI] 0.77 to 1.43; two trials, low‐certainty evidence). In absolute terms at 5 years of follow‐up, this corresponds to 16 more recurrences per 1000 participants (95% CI 79 fewer to 123 more) with 431 recurrences per 1000 participants for ORC. We downgraded the certainty of