Oncologic outcomes after robot-assisted versus open radical cystectomy: a systematic review and meta-analysis

  • Takehiro Iwata
  • Shoji Kimura
  • Beat Foerster
  • Nicola Fossati
  • Alberto Briganti
  • Pierre I. Karakiewicz
  • Kilian M. Gust
  • Shin Egawa
  • Yasutomo Nasu
  • Mohammad Abufaraj
  • Shahrokh F. ShariatEmail author
Invited Review



The efficacy of RARC in oncologic outcomes compared ORC is controversial. We assess potential differences in oncologic outcomes between robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC).


We performed the literature search systematically according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. A pooled meta-analysis was performed to assess the difference in oncologic outcomes between RARC and ORC, separately in randomized controlled trials (RCTs) and non-randomized studies (NRCTs).


Five RCTs and 28 NRCTs were included in this systematic review and meta-analysis. There was no difference in the rate of overall positive surgical margin (PSM) in RCTs, while NRCTs showed a lower rate for RARC. There was no difference in the soft tissue PSM rate between RARC and ORC in both RCTs and NRCTs. There was no difference in the lymph node yield by standard and extended lymph node dissection between RARC and ORC in both RCTs and NRCTs. There was no significant difference in survival outcomes between RARC and ORC in both RCTs and NRCTs.


Based on the current evidence, there is no difference in the rate of PSMs, lymph node yield, recurrence rate and location as well as short-term survival outcomes between RARC and ORC in RCTs. In NRCTs, only PSM rates were better for RARC compared to ORC, but this was likely due to selection and reporting bias which are inherent to retrospective study designs.


Oncologic outcome Open radical cystectomy Positive surgical margin Robot-assisted radical cystectomy 



The authors gratefully acknowledge the contributions of all study participants and staff.

Author contributions

TI: Project development, Data collection, Data analysis, Manuscript writing. SK: Project development, Data collection, Data analysis, Manuscript writing. BF: Project development, Data collection, Data analysis. NF: Manuscript writing (Performed writing discussion section). AB: Manuscript writing (Performed editing introduction and discussion section). PIK: Manuscript writing (Performed critical editing result section). KMG: Manuscript writing (Performed writing result section and editing discussion section). SE: Manuscript writing (Performed writing discussion section). YN: Manuscript writing (Performed critical editing discussion section). MA: Project development, Data collection, Data analysis, Manuscript writing. SFS: Project development, Manuscript writing. All authors read and approved the final manuscript.


None declared.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The authors have no ethical conflicts to disclose.

Informed consent

The ethical approval was unnecessary because this study based on summary and analysis of the results of previous studies.

Supplementary material

345_2019_2708_MOESM1_ESM.tiff (24.9 mb)
Supplementary Figure1. Forest plots showing the comparison of (A) overall positive surgical margin pathological T1-2 and (B) overall positive surgical margin pathological T3-4 between RARC and ORC. CI: confidence interval; M–H: Mantel–Haenszel test; ORC: open radical cystectomy; RARC: robot-assisted radical cystectomy; SD: standard deviation (TIFF 25505 kb)
345_2019_2708_MOESM2_ESM.tiff (24.9 mb)
Supplementary Figure2. Forest plots showing the comparison of (A) standard lymph node yield and (B) extended lymph node yield between RARC and ORC. CI: confidence interval; ORC: open radical cystectomy; RARC: robot-assisted radical cystectomy; SD: standard deviation (TIFF 25505 kb)
345_2019_2708_MOESM3_ESM.tiff (24.9 mb)
Supplementary Figure3. Forest plots showing the comparison of (A) local recurrence and (B) distant recurrence between RARC and ORC. CI: confidence interval; M-H: Mantel–Haenszel test; ORC: open radical cystectomy; RARC: robot-assisted radical cystectomy; SD: standard deviation (TIFF 25505 kb)
345_2019_2708_MOESM4_ESM.docx (19 kb)
Supplementary material 4 (DOCX 19 kb)
345_2019_2708_MOESM5_ESM.doc (71 kb)
Supplementary material 5 (DOC 71 kb)
345_2019_2708_MOESM6_ESM.docx (24 kb)
Supplementary material 6 (DOCX 24 kb)
345_2019_2708_MOESM7_ESM.docx (16 kb)
Supplementary material 7 (DOCX 16 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Takehiro Iwata
    • 1
    • 2
  • Shoji Kimura
    • 1
    • 3
  • Beat Foerster
    • 1
    • 4
  • Nicola Fossati
    • 5
  • Alberto Briganti
    • 5
  • Pierre I. Karakiewicz
    • 6
  • Kilian M. Gust
    • 1
  • Shin Egawa
    • 3
  • Yasutomo Nasu
    • 2
  • Mohammad Abufaraj
    • 1
    • 7
  • Shahrokh F. Shariat
    • 1
    • 8
    • 9
    • 10
    • 11
    Email author
  1. 1.Department of Urology and Comprehensive Cancer Center, Vienna General HospitalMedical University of ViennaViennaAustria
  2. 2.Department of UrologyOkayama University Graduate School of Medicine, Dentistry and Pharmaceutical SciencesOkayamaJapan
  3. 3.Department of UrologyJikei University School of MedicineTokyoJapan
  4. 4.Department of UrologyKantonsspital WinterthurWinterthurSwitzerland
  5. 5.Division of Oncology, Unit of UrologyURI, IRCCS Ospedale San RaffaeleMilanItaly
  6. 6.Division of Urology, Cancer Prognostics and Health Outcomes UnitUniversity of Montreal Health CenterMontrealCanada
  7. 7.Department of Special Surgery, Jordan University HospitalThe University of JordanAmmanJordan
  8. 8.Department of UrologyWeill Cornell Medical CollegeNew YorkUSA
  9. 9.Department of UrologyUniversity of Texas Southwestern Medical CenterDallasUSA
  10. 10.Karl Landsteiner Institute of Urology and AndrologyViennaAustria
  11. 11.Insitute for Urology and Reproductive Health, I.M.Sechenov First Moscow State Medical UniversityMoscowRussia

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