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

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Abstract

Purpose

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).

Methods

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).

Results

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.

Conclusions

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.

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Acknowledgements

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

Funding

None declared.

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Author notes

  1. Takehiro Iwata and Shoji Kimura contributed equally to this project.

Authors and Affiliations

  1. Department of Urology and Comprehensive Cancer Center, Vienna General Hospital, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria

    Takehiro Iwata, Shoji Kimura, Beat Foerster, Kilian M. Gust, Mohammad Abufaraj & Shahrokh F. Shariat

  2. Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

    Takehiro Iwata & Yasutomo Nasu

  3. Department of Urology, Jikei University School of Medicine, Tokyo, Japan

    Shoji Kimura & Shin Egawa

  4. Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland

    Beat Foerster

  5. Division of Oncology, Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy

    Nicola Fossati & Alberto Briganti

  6. Division of Urology, Cancer Prognostics and Health Outcomes Unit, University of Montreal Health Center, Montreal, QC, Canada

    Pierre I. Karakiewicz

  7. Department of Special Surgery, Jordan University Hospital, The University of Jordan, Amman, Jordan

    Mohammad Abufaraj

  8. Department of Urology, Weill Cornell Medical College, New York, NY, USA

    Shahrokh F. Shariat

  9. Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Shahrokh F. Shariat

  10. Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria

    Shahrokh F. Shariat

  11. Insitute for Urology and Reproductive Health, I.M., Sechenov First Moscow State Medical University, Moscow, Russia

    Shahrokh F. Shariat

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  1. Takehiro Iwata
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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.

Corresponding author

Correspondence to Shahrokh F. Shariat.

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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)

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)

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)

Supplementary material 4 (DOCX 19 kb)

Supplementary material 5 (DOC 71 kb)

Supplementary material 6 (DOCX 24 kb)

Supplementary material 7 (DOCX 16 kb)

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Iwata, T., Kimura, S., Foerster, B. et al. Oncologic outcomes after robot-assisted versus open radical cystectomy: a systematic review and meta-analysis. World J Urol 37, 1557–1570 (2019). https://doi.org/10.1007/s00345-019-02708-8

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