Skip to main content

Advertisement

SpringerLink
Log in

Robotic versus open radical cystectomy for bladder cancer: evaluation of complications, survival, and opioid prescribing patterns

  • Research
  • Published:
Journal of Robotic Surgery Aims and scope Submit manuscript

Abstract

We aim to compare complications, readmission, survival, and prescribing patterns of opioids for post-operative pain management for Robotic-assisted laparoscopic radical cystectomy (RARC) as compared to open radical cystectomy (ORC). Patients that underwent RARC or ORC for bladder cancer at a tertiary care center from 2005 to 2021 were included. Recurrence-free survival (RFS) and overall survival (OS) were evaluated with Kaplan–Meier curves and multivariable Cox proportional hazards regression models. Comparisons of narcotic usage were completed with oral morphine equivalents (OMEQ). Multivariable linear regression was used to assess predictors of OMEQ utilization. A total of 128 RARC and 461 ORC patients were included. There was no difference in rates of Clavien-Dindo grade ≥ 3 complications between RARC and ORC (36.7 vs 30.1%, p = 0.16). After a mean follow up of 3.4 years, RFS (HR 0.96, 95%CI 0.58–1.56) and OS (HR 0.69, 95%CI 0.46–1.05) were comparable between RARC and ORC. There was no difference in the narcotic usage between patients in the RARC and ORC groups during the last 24 h of hospitalization (median OMEQ: 0 vs 0, p = 0.33) and upon discharge (median OMEQ: 178 vs 210, p = 0.36). Predictors of higher OMEQ discharge prescriptions included younger age [(− )3.46, 95%CI (−)5.5–(−)0.34], no epidural during hospitalization [− 95.85, 95%CI (− )144.95−(− )107.36], and early time-period of surgery [(− )151.04, 95%CI (− )194.72–(− )107.36]. RARC has comparable 90-day complication rates and early survival outcomes to ORC and remains a viable option for bladder cancer. RARC results in comparable levels of opioid utilization for pain management as ORC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

Data availability statement

All data supporting the findings of this study are available within the paper and its Supplementary Information.

References

  1. Wu J, Xie RY, Cao CZ, Shang BQ, Shi HZ, Shou JZ (2022) Disease management of clinical complete responders to neoadjuvant chemotherapy of muscle-invasive bladder cancer: a review of literature. Front Oncol 12:816444. https://doi.org/10.3389/fonc.2022.816444

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Hussein AA, Li Q, Guru KA (2022) Robot-assisted radical cystectomy: surgical technique, perioperative and oncologic outcomes. Curr Opin Urol 32(1):116–122. https://doi.org/10.1097/MOU.0000000000000953

    Article  PubMed  Google Scholar 

  3. Smith AB, Raynor M, Amling CL et al (2012) Multi-institutional analysis of robotic radical cystectomy for bladder cancer: perioperative outcomes and complications in 227 patients. J Laparoendosc Adv Surg Tech 22(1):17–21. https://doi.org/10.1089/lap.2011.0326

    Article  Google Scholar 

  4. Mortezavi A, Crippa A, Kotopouli MI, Akre O, Wiklund P, Hosseini A (2022) Association of open vs robot-assisted radical cystectomy with mortality and perioperative outcomes among patients with bladder cancer in Sweden. JAMA Netw Open 5(4):e228959. https://doi.org/10.1001/jamanetworkopen.2022.8959

    Article  PubMed  PubMed Central  Google Scholar 

  5. Moschovas MC, Seetharam Bhat KR, Jenson C, Patel VR, Ogaya-Pinies G (2021) Robtic-assisted radical cystectomy: literature review. Asian J Urol 8(1):14–19. https://doi.org/10.1016/j.ajur.2020.06.007

    Article  PubMed  Google Scholar 

  6. Parekh DJ, Reis IM, Castle EP et al (2018) Robot-assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer (RAZOR): an open-label, randomised, phase 3, non-inferiority trial. Lancet 391(10139):2525–2536. https://doi.org/10.1016/S0140-6736(18)30996-6

    Article  PubMed  Google Scholar 

  7. Azhar RA, Bochner B, Catto J et al (2016) Enhanced recovery after urological surgery: a contemporary systematic review of outcomes, key elements, and research needs. Eur Urol 70(1):176–187. https://doi.org/10.1016/j.eururo.2016.02.051

    Article  PubMed  PubMed Central  Google Scholar 

  8. Venkatramani V, Reis IM, Castle EP et al (2020) Predictors of recurrence, and progression-free and overall survival following open versus robotic radical cystectomy: analysis from the RAZOR trial with a 3-year followup. J Urol 203(3):522–529. https://doi.org/10.1097/JU.0000000000000565

    Article  PubMed  Google Scholar 

  9. Su ZT, Becker RE, Huang MM et al (2022) Patient and in-hospital predictors of post-discharge opioid utilization: individualizing prescribing after radical prostatectomy based on the ORIOLES initiative. Urol Oncol 40(3):104.e9-104.e15. https://doi.org/10.1016/j.urolonc.2021.10.007

    Article  CAS  PubMed  Google Scholar 

  10. Wijburg CJ, Michels CTJ, Hannink G et al (2021) Robot-assisted radical cystectomy versus open radical cystectomy in bladder cancer patients: a multicentre comparative effectiveness study. Eur Urol 79(5):609–618. https://doi.org/10.1016/j.eururo.2020.12.023

    Article  PubMed  Google Scholar 

  11. Maibom SL, Roder MA, Aasvang EK et al (2022) Open vs robot-assisted radical cystectomy (BORARC): a double-blinded, randomised feasibility study. BJU Int 130(1):102–113. https://doi.org/10.1111/bju.15619

    Article  PubMed  Google Scholar 

  12. Myrga JM, Wu S, Gul ZG et al (2022) Discharge opioids are unnecessary following radical cystectomy. Urology 170:91–95. https://doi.org/10.1016/j.urology.2022.08.025

    Article  CAS  PubMed  Google Scholar 

  13. Lombardo R, Mastroianni R, Tuderti G et al (2021) Benchmarking PASADENA consensus along the learning curve of robotic radical cystectomy with intracorporeal neobladder: CUSUM based assessment. J Clin Med 10(24):5969. https://doi.org/10.3390/jcm10245969

    Article  PubMed  PubMed Central  Google Scholar 

  14. Semerjian A, Milbar N, Kates M et al (2018) Hospital charges and length of stay following radical cystectomy in the enhanced recovery after surgery era. Urology 111:86–91. https://doi.org/10.1016/j.urology.2017.09.010

    Article  PubMed  Google Scholar 

  15. Abaza R, Kogan P, Martinez O (2022) Narcotic avoidance after robotic radical cystectomy allows routine of only two-day hospital stay. Urology 161:65–70. https://doi.org/10.1016/j.urology.2021.10.049

    Article  PubMed  Google Scholar 

  16. Pfail JL, Garden EB, Gul Z et al (2021) Implementation of a nonopioid protocol following robot-assisted radical cystectomy with intracorporeal urinary diversion. Urol Oncol 39(7):436 e9-436 e16. https://doi.org/10.1016/j.urolonc.2021.01.002

    Article  CAS  PubMed  Google Scholar 

  17. Tan YG, Allen JC, Tay KJ, Huang HH, Lee LS (2020) Benefits of robotic cystectomy compared with open cystectomy in an Enhanced Recovery After Surgery program: a propensity-matched analysis. Int J Urol 27(9):783–788. https://doi.org/10.1111/iju.14300

    Article  CAS  PubMed  Google Scholar 

  18. Catto JWF, Khetrapal P, Ricciardi F et al (2022) Effect of robot-assisted radical cystectomy with intracorporeal urinary diversion vs open radical cystectomy on 90-day morbidity and mortality among patients with bladder cancer: a randomized clinical trial. JAMA 327:2092. https://doi.org/10.1001/jama.2022.7393

    Article  PubMed  PubMed Central  Google Scholar 

  19. Mastroianni R, Ferriero M, Tuderti G et al (2022) Open radical cystectomy versus robot-assisted radical cystectomy with intracorporeal urinary diversion: early outcomes of a single-center randomized controlled trial. J Urol 207(5):982–992. https://doi.org/10.1097/JU.0000000000002422

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

None.

Funding

No funds, grants, or other support was received.

Author information

Authors and Affiliations

  1. Department of Urology, Loyola University Medical Center, Maywood, IL, 60153, USA

    Rachel Yang, Goran Rac, Michael D. Felice, Gaurav Pahouja, Caitlyn Ko, Yudai Okabe, Ushasi Naha, Victor S. Chen, Gopal N. Gupta, Michael E. Woods, Alex Gorbonos, Marcus L. Quek & Hiten D. Patel

  2. Department of Urology, University of South Florida, Tampa, FL, USA

    Aleksander Druck

  3. Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Hiten D. Patel

Authors
  1. Rachel Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Goran Rac
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael D. Felice
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Gaurav Pahouja
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Caitlyn Ko
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yudai Okabe
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ushasi Naha
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Victor S. Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Aleksander Druck
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Gopal N. Gupta
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Michael E. Woods
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Alex Gorbonos
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Marcus L. Quek
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Hiten D. Patel
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Protocol/project development: HP, GR, GP, GG, MW, AG, MQ. Data collection or management: RY, HP, GR, MF, GP, CK, YO, UN, VC, AD. Data analysis: HP, GR, MF. Manuscript writing/editing: RY, HP, GR, MF, GG, MW, AG, MQ. Protocol/project development: HP, GR, GP, GG, MW, AG, MQ. Data collection or management: RY, HP, GR, MF, GP, CK, YO, UN, VC, AD. Data analysis: HP, GR, MF. Manuscript writing/editing: RY, HP, GR, MF, GG, MW, AG, MQ.

Corresponding authors

Correspondence to Goran Rac or Victor S. Chen.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

Given its retrospective nature, this project was exempted by the Institutional Review board from review.

Consent to Participate

Given its retrospective nature, this project was exempted by the Institutional Review board from needing consent to participate.

Consent to Publish

Given its retrospective nature, this project was exempted by the Institutional Review board from needing consent to publish.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Yang, R., Rac, G., Felice, M.D. et al. Robotic versus open radical cystectomy for bladder cancer: evaluation of complications, survival, and opioid prescribing patterns. J Robotic Surg 18, 10 (2024). https://doi.org/10.1007/s11701-023-01749-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s11701-023-01749-x

Keywords

Search

Navigation