Robot-assisted Radical Cystectomy Versus Open Radical Cystectomy: A Systematic Review and Meta-analysis of Perioperative, Oncological, and Quality of Life Outcomes Using Randomized Controlled Trials
Robot-assisted radical cystectomy is associated with less blood loss, fewer transfusions, longer operative times, shorter hospital length of stay, and better physical/role functioning compared with open radical cystectomy (ORC). ORC had higher rates of thromboembolic events. Limitations may include...
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| Veröffentlicht in: | EUROPEAN UROLOGY 2023-10, Vol.84 (4), p.393-405 |
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| creator | Khetrapal, Pramit Wong, Joanna Kae Ling Tan, Wei Phin Rupasinghe, Thiara Tan, Wei Shen Williams, Stephen B. Boorjian, Stephen A. Wijburg, Carl Parekh, Dipen J. Wiklund, Peter Vasdev, Nikhil Khan, Muhammad Shamim Guru, Khurshid A. Catto, James W.F. Kelly, John D. |
| description | Robot-assisted radical cystectomy is associated with less blood loss, fewer transfusions, longer operative times, shorter hospital length of stay, and better physical/role functioning compared with open radical cystectomy (ORC). ORC had higher rates of thromboembolic events. Limitations may include a lack of generalization given that trial patients and design may not reflect real-world evidence.
Differences in recovery, oncological, and quality of life (QoL) outcomes between open radical cystectomy (ORC) and robot-assisted radical cystectomy (RARC) for patients with bladder cancer are unclear.
This review aims to compare these outcomes within randomized trials of ORC and RARC in this context. The primary outcome was the rate of 90-d perioperative events. The secondary outcomes included operative, pathological, survival, and health-related QoL (HRQoL) measures.
Systematic literature searches of MEDLINE, Embase, Web of Science, and clinicaltrials.gov were performed up to May 31, 2022.
Eight trials, reporting 1024 participants, were included. RARC was associated with a shorter hospital length of stay (LOS; mean difference [MD] 0.21, 95% confidence interval [CI] 0.03–0.39, p = 0.02) than and similar complication rates 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 |
| doi_str_mv | 10.1016/j.eururo.2023.04.004 |
| format | Article |
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Differences in recovery, oncological, and quality of life (QoL) outcomes between open radical cystectomy (ORC) and robot-assisted radical cystectomy (RARC) for patients with bladder cancer are unclear.
This review aims to compare these outcomes within randomized trials of ORC and RARC in this context. The primary outcome was the rate of 90-d perioperative events. The secondary outcomes included operative, pathological, survival, and health-related QoL (HRQoL) measures.
Systematic literature searches of MEDLINE, Embase, Web of Science, and clinicaltrials.gov were performed up to May 31, 2022.
Eight trials, reporting 1024 participants, were included. RARC was associated with a shorter hospital length of stay (LOS; mean difference [MD] 0.21, 95% confidence interval [CI] 0.03–0.39, p = 0.02) than and similar complication rates 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 76 min, 95% CI 39–112, p < 0.001) than RARC. No differences in lymph node yield (MD 1.07, 95% CI –1.73 to 3.86, p = 0.5) or positive surgical margin rates (OR 0.95, 95% CI 0.54–1.67, p = 0.9) were present. RARC was associated with better physical functioning or well-being (standardized MD 0.47, 95% CI 0.29–0.65, p < 0.001) and role functioning (MD 8.8, 95% CI 2.4–15.1, p = 0.007), but no improvement in overall HRQoL. No differences in progression-free survival or overall survival were seen. Limitations may include a lack of generalization given trial patients.
RARC offers various perioperative benefits over ORC. It may be more suitable in patients wishing to avoid blood transfusion, those wanting a shorter LOS, or those at a high risk of thromboembolic events.
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.</description><identifier>ISSN: 0302-2838</identifier><identifier>EISSN: 1873-7560</identifier><identifier>DOI: 10.1016/j.eururo.2023.04.004</identifier><identifier>PMID: 37169638</identifier><language>eng</language><publisher>Switzerland: Elsevier B.V</publisher><subject>Bladder cancer ; Complications ; Cystectomy ; Open radical cystectomy ; Quality of life ; Radical cystectomy ; Robot-assisted radical cystectomy ; Robotic surgery ; Survival</subject><ispartof>EUROPEAN UROLOGY, 2023-10, Vol.84 (4), p.393-405</ispartof><rights>2023 The Authors</rights><rights>Copyright © 2023 The Authors. Published by Elsevier B.V. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3614-3be8eb374bbefd385c6c1bf0c9ba3f2f529975fcc57051f55b17dcc96c285d6e3</citedby><cites>FETCH-LOGICAL-c3614-3be8eb374bbefd385c6c1bf0c9ba3f2f529975fcc57051f55b17dcc96c285d6e3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://dx.doi.org/10.1016/j.eururo.2023.04.004$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>230,314,552,780,784,885,3548,27923,27924,45994</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37169638$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:237169638$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Khetrapal, Pramit</creatorcontrib><creatorcontrib>Wong, Joanna Kae Ling</creatorcontrib><creatorcontrib>Tan, Wei Phin</creatorcontrib><creatorcontrib>Rupasinghe, Thiara</creatorcontrib><creatorcontrib>Tan, Wei Shen</creatorcontrib><creatorcontrib>Williams, Stephen B.</creatorcontrib><creatorcontrib>Boorjian, Stephen A.</creatorcontrib><creatorcontrib>Wijburg, Carl</creatorcontrib><creatorcontrib>Parekh, Dipen J.</creatorcontrib><creatorcontrib>Wiklund, Peter</creatorcontrib><creatorcontrib>Vasdev, Nikhil</creatorcontrib><creatorcontrib>Khan, Muhammad Shamim</creatorcontrib><creatorcontrib>Guru, Khurshid A.</creatorcontrib><creatorcontrib>Catto, James W.F.</creatorcontrib><creatorcontrib>Kelly, John D.</creatorcontrib><title>Robot-assisted Radical Cystectomy Versus Open Radical Cystectomy: A Systematic Review and Meta-analysis of Perioperative, Oncological, and Quality of Life Outcomes Using Randomized Controlled Trials</title><title>EUROPEAN UROLOGY</title><addtitle>Eur Urol</addtitle><description>Robot-assisted radical cystectomy is associated with less blood loss, fewer transfusions, longer operative times, shorter hospital length of stay, and better physical/role functioning compared with open radical cystectomy (ORC). ORC had higher rates of thromboembolic events. Limitations may include a lack of generalization given that trial patients and design may not reflect real-world evidence.
Differences in recovery, oncological, and quality of life (QoL) outcomes between open radical cystectomy (ORC) and robot-assisted radical cystectomy (RARC) for patients with bladder cancer are unclear.
This review aims to compare these outcomes within randomized trials of ORC and RARC in this context. The primary outcome was the rate of 90-d perioperative events. The secondary outcomes included operative, pathological, survival, and health-related QoL (HRQoL) measures.
Systematic literature searches of MEDLINE, Embase, Web of Science, and clinicaltrials.gov were performed up to May 31, 2022.
Eight trials, reporting 1024 participants, were included. RARC was associated with a shorter hospital length of stay (LOS; mean difference [MD] 0.21, 95% confidence interval [CI] 0.03–0.39, p = 0.02) than and similar complication rates 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 76 min, 95% CI 39–112, p < 0.001) than RARC. No differences in lymph node yield (MD 1.07, 95% CI –1.73 to 3.86, p = 0.5) or positive surgical margin rates (OR 0.95, 95% CI 0.54–1.67, p = 0.9) were present. RARC was associated with better physical functioning or well-being (standardized MD 0.47, 95% CI 0.29–0.65, p < 0.001) and role functioning (MD 8.8, 95% CI 2.4–15.1, p = 0.007), but no improvement in overall HRQoL. No differences in progression-free survival or overall survival were seen. Limitations may include a lack of generalization given trial patients.
RARC offers various perioperative benefits over ORC. It may be more suitable in patients wishing to avoid blood transfusion, those wanting a shorter LOS, or those at a high risk of thromboembolic events.
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.</description><subject>Bladder cancer</subject><subject>Complications</subject><subject>Cystectomy</subject><subject>Open radical cystectomy</subject><subject>Quality of life</subject><subject>Radical cystectomy</subject><subject>Robot-assisted radical cystectomy</subject><subject>Robotic surgery</subject><subject>Survival</subject><issn>0302-2838</issn><issn>1873-7560</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>D8T</sourceid><recordid>eNp9kU1v1DAQhi0EosvCP0DIRw5NsOM4HxyQqhUUpEULS8vV8sek8pLEi520Sn8gvwuHLD0hfJkZ-5l3Rn4ReklJSgkt3hxSGP3oXZqRjKUkTwnJH6EVrUqWlLwgj9GKMJIlWcWqM_QshAMhhPGaPUVnrKRFXbBqhX7tnXJDIkOwYQCD99JYLVu8mWKpB9dN-Dv4MAa8O0L_j-e3-AJ_m6tODlbjPdxauMOyN_gzDDKRvWynqI1dg7-At-4IPoK3cI53vXatu5n1zv80fB1la4dpRre2AbwbB-06CPg62P4mzu6N6-x93HLj-sG7to3plbeyDc_RkyYGeHGKa3T94f3V5mOy3V1-2lxsE80KmidMQQWKlblS0BhWcV1oqhqiayVZkzU8q-uSN1rzknDacK5oabSuC51V3BTA1ihZdMMdHEcljt520k_CSStOVz9iBqLiBYtnjV4v_NG7nyOEQXQ2aGhb2YMbg8gqyjivSDmj-YJq70Lw0DyIUyJmx8VBLI6L2XFBchEdj22vThNG1YF5aPprcQTeLQDEf4nmeBG0hV6DsT5aKIyz_5_wG8R2xGo</recordid><startdate>20231001</startdate><enddate>20231001</enddate><creator>Khetrapal, Pramit</creator><creator>Wong, Joanna Kae Ling</creator><creator>Tan, Wei Phin</creator><creator>Rupasinghe, Thiara</creator><creator>Tan, Wei Shen</creator><creator>Williams, Stephen B.</creator><creator>Boorjian, Stephen A.</creator><creator>Wijburg, Carl</creator><creator>Parekh, Dipen J.</creator><creator>Wiklund, Peter</creator><creator>Vasdev, Nikhil</creator><creator>Khan, Muhammad Shamim</creator><creator>Guru, Khurshid A.</creator><creator>Catto, James W.F.</creator><creator>Kelly, John D.</creator><general>Elsevier B.V</general><scope>6I.</scope><scope>AAFTH</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>ZZAVC</scope></search><sort><creationdate>20231001</creationdate><title>Robot-assisted Radical Cystectomy Versus Open Radical Cystectomy: A Systematic Review and Meta-analysis of Perioperative, Oncological, and Quality of Life Outcomes Using Randomized Controlled Trials</title><author>Khetrapal, Pramit ; Wong, Joanna Kae Ling ; Tan, Wei Phin ; Rupasinghe, Thiara ; Tan, Wei Shen ; Williams, Stephen B. ; Boorjian, Stephen A. ; Wijburg, Carl ; Parekh, Dipen J. ; Wiklund, Peter ; Vasdev, Nikhil ; Khan, Muhammad Shamim ; Guru, Khurshid A. ; Catto, James W.F. ; Kelly, John D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3614-3be8eb374bbefd385c6c1bf0c9ba3f2f529975fcc57051f55b17dcc96c285d6e3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Bladder cancer</topic><topic>Complications</topic><topic>Cystectomy</topic><topic>Open radical cystectomy</topic><topic>Quality of life</topic><topic>Radical cystectomy</topic><topic>Robot-assisted radical cystectomy</topic><topic>Robotic surgery</topic><topic>Survival</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Khetrapal, Pramit</creatorcontrib><creatorcontrib>Wong, Joanna Kae Ling</creatorcontrib><creatorcontrib>Tan, Wei Phin</creatorcontrib><creatorcontrib>Rupasinghe, Thiara</creatorcontrib><creatorcontrib>Tan, Wei Shen</creatorcontrib><creatorcontrib>Williams, Stephen B.</creatorcontrib><creatorcontrib>Boorjian, Stephen A.</creatorcontrib><creatorcontrib>Wijburg, Carl</creatorcontrib><creatorcontrib>Parekh, Dipen J.</creatorcontrib><creatorcontrib>Wiklund, Peter</creatorcontrib><creatorcontrib>Vasdev, Nikhil</creatorcontrib><creatorcontrib>Khan, Muhammad Shamim</creatorcontrib><creatorcontrib>Guru, Khurshid A.</creatorcontrib><creatorcontrib>Catto, James W.F.</creatorcontrib><creatorcontrib>Kelly, John D.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SwePub Articles full text</collection><jtitle>EUROPEAN UROLOGY</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Khetrapal, Pramit</au><au>Wong, Joanna Kae Ling</au><au>Tan, Wei Phin</au><au>Rupasinghe, Thiara</au><au>Tan, Wei Shen</au><au>Williams, Stephen B.</au><au>Boorjian, Stephen A.</au><au>Wijburg, Carl</au><au>Parekh, Dipen J.</au><au>Wiklund, Peter</au><au>Vasdev, Nikhil</au><au>Khan, Muhammad Shamim</au><au>Guru, Khurshid A.</au><au>Catto, James W.F.</au><au>Kelly, John D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Robot-assisted Radical Cystectomy Versus Open Radical Cystectomy: A Systematic Review and Meta-analysis of Perioperative, Oncological, and Quality of Life Outcomes Using Randomized Controlled Trials</atitle><jtitle>EUROPEAN UROLOGY</jtitle><addtitle>Eur Urol</addtitle><date>2023-10-01</date><risdate>2023</risdate><volume>84</volume><issue>4</issue><spage>393</spage><epage>405</epage><pages>393-405</pages><issn>0302-2838</issn><eissn>1873-7560</eissn><abstract>Robot-assisted radical cystectomy is associated with less blood loss, fewer transfusions, longer operative times, shorter hospital length of stay, and better physical/role functioning compared with open radical cystectomy (ORC). ORC had higher rates of thromboembolic events. Limitations may include a lack of generalization given that trial patients and design may not reflect real-world evidence.
Differences in recovery, oncological, and quality of life (QoL) outcomes between open radical cystectomy (ORC) and robot-assisted radical cystectomy (RARC) for patients with bladder cancer are unclear.
This review aims to compare these outcomes within randomized trials of ORC and RARC in this context. The primary outcome was the rate of 90-d perioperative events. The secondary outcomes included operative, pathological, survival, and health-related QoL (HRQoL) measures.
Systematic literature searches of MEDLINE, Embase, Web of Science, and clinicaltrials.gov were performed up to May 31, 2022.
Eight trials, reporting 1024 participants, were included. RARC was associated with a shorter hospital length of stay (LOS; mean difference [MD] 0.21, 95% confidence interval [CI] 0.03–0.39, p = 0.02) than and similar complication rates 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 76 min, 95% CI 39–112, p < 0.001) than RARC. No differences in lymph node yield (MD 1.07, 95% CI –1.73 to 3.86, p = 0.5) or positive surgical margin rates (OR 0.95, 95% CI 0.54–1.67, p = 0.9) were present. RARC was associated with better physical functioning or well-being (standardized MD 0.47, 95% CI 0.29–0.65, p < 0.001) and role functioning (MD 8.8, 95% CI 2.4–15.1, p = 0.007), but no improvement in overall HRQoL. No differences in progression-free survival or overall survival were seen. Limitations may include a lack of generalization given trial patients.
RARC offers various perioperative benefits over ORC. It may be more suitable in patients wishing to avoid blood transfusion, those wanting a shorter LOS, or those at a high risk of thromboembolic events.
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.</abstract><cop>Switzerland</cop><pub>Elsevier B.V</pub><pmid>37169638</pmid><doi>10.1016/j.eururo.2023.04.004</doi><tpages>13</tpages><oa>free_for_read</oa></addata></record> |
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| source | SWEPUB Freely available online; ScienceDirect Journals (5 years ago - present) |
| subjects | Bladder cancer Complications Cystectomy Open radical cystectomy Quality of life Radical cystectomy Robot-assisted radical cystectomy Robotic surgery Survival |
| title | Robot-assisted Radical Cystectomy Versus Open Radical Cystectomy: A Systematic Review and Meta-analysis of Perioperative, Oncological, and Quality of Life Outcomes Using Randomized Controlled Trials |
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