J Urol: Comparison of early outcomes between open radical cystectomy and robotic-assisted radical cystectomy

Radical cystectomy (RC) with urinary diversion (UD) remains a complex procedure with high morbidity
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Although the use of robotic-assisted cystectomy (RARC) is rapidly increasing, open cystectomy (ORC) remains the treatment of choice

All available RCTs perform UD with cardiopulmonary bypass, diminishing the potential benefit of fully minimally invasive surgery

Recently, researchers from Italy, published in J Urol, investigated and reported the perioperative and 6-month (mo) comparative outcomes of ORC and RARC (both with completely extracorporeal (i)UD)
.

Investigated and reported the perioperative and 6-month (mo) comparative outcomes of ORC and RARC (both with total extracorporeal (i)UD) Comparing Outcomes During Surgery and 6 Months (mo)

Study participants who were TURBt patients with a diagnosis of cT2-4, cN0, cM0, or recurrent high-grade non-muscle-invasive bladder cancer and who had no contraindications to anesthesia for robotic surgery were eligible for randomization
.

Patients were enrolled according to the following variables and using a covariate adaptive randomization procedure

The primary endpoint was to demonstrate the superiority of RARC with i-UD in reducing the transfusion rate by 50% The primary endpoint was to demonstrate the superiority of RARC with i-UD in reducing the transfusion rate by 50%

Between January 2018 and September 2020, 274 patients were scheduled for RC; 96 of these were excluded for palliative intent
.

Of the 178 patients evaluated for eligibility, 62 declined randomization, resulting in a final enrollment of 116 consecutive patients (58 RARC, 58 ORC), an enrollment rate of 65%

Overall, both cohorts experienced significant deterioration in physical function, role function, fatigue, constipation, bloating and gas, body image, and sexual function
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Patients who received ORC were more likely to experience dyspnea, loss of appetite, diarrhea, and urinary symptoms and problems; while patients who received RARC also had a significantly worse future outlook

The total perioperative transfusion rate was significantly lower in the RARC cohort (RARC: 22% vs ORC: 41%; P=0.

Kaplan-Meier curves for survival outcomes

Kaplan-Meier curves for survival outcomes

In conclusion, this prospective randomized trial observed a total perioperative transfusion rate of 22% and 41% in patients treated with RARC and ORC, respectively, confirming the significant advantage of RARC with i-UD
.

Oncological and functional outcomes will need to be assessed at longer follow-up to observe potential differences between groups

This prospective randomized trial observed a total perioperative transfusion rate of 22% and 41% in patients treated with RARC and ORC, respectively, confirming the significant advantage of RARC with i-UD

Original source:

Original source:

Riccardo Mastroianni, Mariaconsiglia Ferriero, Gabriele Tuderti et al.

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