Robotic-assisted radical cystectomies (RARC) are consistently associated with lower estimated blood loss (EBL) and lower transfusion risk than open radical cystectomies (ORC) for patients with bladder cancer, according to a new study in Annals of Surgical Oncology.
An ORC removes the entire bladder and surrounding lymph nodes once the cancer has spread to more than one part of the bladder. Whereas ORCs are typically done through a small incision in the abdomen, RARCs are done through multiple smaller incisions, using longer instruments with a camera lens attached to allow the surgeon to see inside the body. The surgeon controls these instruments with robotic arms via a control panel.
The authors systematically reviewed MEDLINE, Medline-in-Process, Medline Epubs Ahead of Print, and the Cochrane Library for randomized review articles on adult bladder cancer patients undergoing RARC or ORC, excluding non-randomized reviews to avoid confounding and selection bias. The researchers used the GRADE approach to determine the confidence in estimates and the AMSTAR 2 checklist to properly assess the quality of the 6 systematic reviews and meta-analyses.
Researchers concluded that RARCs are consistently associated with lower estimated blood loss and lower transfusion rates but longer operative duration. Results regarding the impact of RARC on hospital length of stay were inconclusive. There was no significant difference between the 2 modes of operation regarding the overall complication rate, major complication rate, or oncologic outcomes. Overall quality of life (QOL) outcomes were incomparable due to the lack of similar statistical methodology between each systematic review. Prospective studies are needed to properly assess the impact of the type of technique and different recovery pathways on cost and patient QOL.
Robotic versus open cystectomy for bladder cancer: synthesizing the data from current systematic reviews and meta-analyses