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Comparison of perioperative and oncologic outcomes between robot-assisted and laparoscopic radical cystectomy for bladder cancer: a systematic review and updated meta-analysis

  • Urology - Review
  • Published:
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Abstract

Objective

Currently, there is limited evidence comparing robot-assisted radical cystectomy (RARC) to laparoscopic radical cystectomy (LRC). The purpose of this study is to systematically review the literature and conduct a meta-analysis.

Materials and methods

We conducted a systematic literature search to identify matching publications regarding RARC and LRC for bladder cancer through PubMed/Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) and Web of Science with no restriction to date and language. The evaluated outcomes include perioperative outcomes (i.e. days to oral intake, operative time, estimated blood loss (EBL), transfusion rates, length of stay (LOS) and complication rates) and oncological outcomes (i.e. positive surgical margin (PSM), lymph node yield, and overall survival (OS)).

Results

After screening 780 articles, 10 studies were included in the final meta-analysis. We found that there was no significant difference with regard to basic demographic variables, operative time, and PSM. There were statistically significant shorter LOS (MD − 0.63, 95% CI − 1.24, 0.03), fewer complication rates (the risk ratios were 0.74 and 0.49 for Clavien grade 1–2 and Clavien grade 3–5,respectively), more lymph node yield (MD 2.38, 95% CI 1.89–2.87) and less death risk (HR 0.26, 95% CI 0.17–0.39) in RARC group compared with LRC group.

Conclusions

Our findings indicated that patients with RARC may benefit from significantly lower complications, shorter LOS, higher lymph node yield and lower death risk. These data thus showed that RARC might improve the management of patients with muscle invasive or high-risk non-muscle invasive bladder cancer.

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Funding

The study was supported by the 1.3.5 project for disciplines of excellence, West China Hospital, Sichuan University (ZY2016104) and Pillar Program from Department of Science and Technology of Sichuan Province (2018SZ0219).

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Author notes

  1. Dechao Feng and Shengzhuo Liu were contributed equally to this work and should be considered as co-first author.

Authors and Affiliations

  1. Department of Urology, Institute of Urology, West China Hospital, Sichuan University, Guoxue Xiang #37, Chengdu, 610041, Sichuan, People’s Republic of China

    Dechao Feng, Shengzhuo Liu, Yin Tang, Yubo Yang, Wuran Wei & Ping Han

Authors
  1. Dechao Feng
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  2. Shengzhuo Liu
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  3. Yin Tang
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Contributions

DCF: project development, data collection, data analysis, manuscript writing; SZL: data collection, data analysis; YT: data collection; WRW: data management; YBY: data management, data analysis; PH: manuscript editing.

Corresponding authors

Correspondence to Wuran Wei or Ping Han.

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Appendix

Appendix

Search strategy ((((robot-assisted [Title/Abstract]) OR robotic [Title/Abstract])) AND laparoscopic [Title/Abstract]) AND radical cystectomy [Title/Abstract] 220 records

PubMed/Medline, Embase and Cochrane Central Register of Controlled Trials (CENTRAL) databases by Ovid (laparoscopic [keyword]) AND (Robot* [keyword]) AND radical cystectomy [keyword] 26 records.

Web of Science (Robot* [subject]) AND (laparoscopic [subject]) AND radical cystectomy[subject] 527 records.

The risk of bias of Patel 2011 [20] and Khan 2016 [19]

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Feng, D., Liu, S., Tang, Y. et al. Comparison of perioperative and oncologic outcomes between robot-assisted and laparoscopic radical cystectomy for bladder cancer: a systematic review and updated meta-analysis. Int Urol Nephrol 52, 1243–1254 (2020). https://doi.org/10.1007/s11255-020-02406-0

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  • DOI: https://doi.org/10.1007/s11255-020-02406-0

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