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Eur J Surg Oncol. 2016 Nov;42(11):1736-1743. doi: 10.1016/j.ejso.2016.02.254. Epub 2016 Mar 19.

Perioperative and oncologic outcomes of robot-assisted vs. open radical cystectomy in bladder cancer patients: A comparison of two high-volume referral centers.

Author information

1
Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium; OLV Vattikuti Robotic Surgery Institute, Melle, Belgium; Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy. Electronic address: giorgio.gandaglia@gmail.com.
2
Department of Urology, LMU Munich, Munich, Germany.
3
OLV Vattikuti Robotic Surgery Institute, Melle, Belgium; Department of Surgery, Oncology, and Gastroenterology, Urology Clinic, University of Padua, Padua, Italy.
4
Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium.
5
Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy.
6
Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium; OLV Vattikuti Robotic Surgery Institute, Melle, Belgium.
7
Department of Urology, Onze-Lieve-Vrouw Hospital, Aalst, Belgium; Department of Urology, LMU Munich, Munich, Germany.

Abstract

OBJECTIVES:

To examine perioperative and oncologic outcomes of open (ORC) and robot-assisted radical cystectomy (RARC) in bladder cancer (BCa) patients.

METHODS AND MATERIALS:

368 consecutive patients with cT1-4 M0 BCa treated at two high-volume European centers between 2004 and 2013 were evaluated. Data on complications, operative time, blood loss, postoperative transfusion, reoperation, length of stay (LOS), positive margins, recurrence, cancer-specific mortality (CSM), and overall survival were evaluated. Uni- and multivariable regression analyses tested the impact of the surgical approach on perioperative and oncologic outcomes.

RESULTS:

Overall, 230 (62.5%) and 138 (37.5%) patients were treated with ORC and RARC. In multivariable analyses RARC patients had higher odds of prolonged operative time and low-grade complications (all P ≤ 0.001). Patients treated with ORC had higher odds of blood loss >500 ml and prolonged LOS (all P ≤ 0.03). No differences were observed in high-grade complications and positive margins (all P ≥ 0.06). No differences were observed in 5-year recurrence-free and CSM-free survival rates between patients treated with ORC vs. RARC (57.1 vs. 54.2% and 61.9 vs. 73.5%; all P ≥ 0.3). This was confirmed in multivariable analyses, where the surgical approach was not associated with the risk of recurrence and CSM (all P ≥ 0.1).

CONCLUSIONS:

Although ORC might be associated with a shorter operative time, RARC led to lower blood loss and shorter LOS. No differences exist in high-grade complications and positive margins. RARC and ORC provide similar oncologic control.

KEYWORDS:

Bladder cancer; Comparative effectiveness; Open; Radical cystectomy; Robot-assisted

PMID:
27032295
DOI:
10.1016/j.ejso.2016.02.254
[Indexed for MEDLINE]

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