Open vs. robot-assisted radical cystectomy with extracorporeal or intracorporeal urinary diversion for bladder cancer

A pairwise meta-analysis of outcomes and a network meta-analysis of complications

Authors

  • Carlos Riveros Department of Urology, Houston Methodist Hospital, Houston, Texas, USA https://orcid.org/0000-0001-8030-6605
  • Sanjana Ranganathan Department of Urology, Houston Methodist Hospital, Houston, Texas, USA
  • Cole Nipper Department of Urology, Houston Methodist Hospital, Houston, Texas, USA
  • Kelvin Lim Department of Urology, Houston Methodist Hospital, Houston, Texas, USA
  • Michael Brooks Department of Urology, Houston Methodist Hospital, Houston, Texas, USA
  • Furkan Dursun Department of Urology, University of Texas Health, San Antonio, Texas, USA
  • Brian J. Miles Department of Urology, Houston Methodist Hospital, Houston, Texas, USA
  • Alvin C. Goh Urology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
  • Mihir Desai USC Institute of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
  • Zachary Klaasen Division of Urology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
  • Girish S. Kulkarni Division of Urology and Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Urology, University of Toronto, Toronto, Ontario, Canada
  • Christopher J.D. Wallis Division of Urology and Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada; Division of Urology, University of Toronto, Toronto, Ontario, Canada; Division of Urology, Mount Sinai Hospital, Toronto, Ontario, Canada
  • Raj Satkunasivam Department of Urology, Houston Methodist Hospital, Houston, Texas, USA

DOI:

https://doi.org/10.5489/cuaj.8096

Keywords:

cystectomy, urinary diversion, robotic surgical procedures, randomized controlled trial, patient outcome assessment

Abstract

INTRODUCTION: There are no meta-analyses of randomized controlled trials (RCTs) comparing open radical cystectomy (OR C) with robot-assisted radical cystectomy (RARC), inclusive of both intracorporeal (iRARC) and extracorporeal (hybrid RARC, hRARC) urinary reconstruction.

METHODS: MEDLINE, Embase, Scopus, the International Clinical Trials Registry Platform and ClinicalTrials.gov registries were searched in May 2022. Outcomes of interest included recurrence- or progression-free survival (RFS/PFS), margin status and lymph node yield, mean estimated blood loss (EBL) and operating room time (ORT ), hospital length of stay (LOS ), 90-day complications and readmissions, and quality of life (QoL). Pairwise meta-analyses and network meta-analyses were performed using random-effects models and Bayesian hierarchical random-effects models, respectively.

RESULTS: We found no significant differences between RARC and OR C for oncological and most perioperative outcomes: RFS/PFS (hazard ratio [HR ] 0.91, 95% confidence interval [CI] 0.67–1.23); positive surgical margins (odds ratio [OR ] 1.05, 95% CI 0.60–1.85); lymph node yield (mean difference [MD ] -0.63, 95% CI -2.63–1.37); LOS (MD -0.22, 95% CI -1.10–0.65); overall complications (OR 0.81, 95% CI 0.61–1.07); major complications (OR 0.94, 95% CI 0.69–1.30); readmissions (OR 0.90, 95% CI 0.60–1.35); and QoL (standardized MD -0.02, 95% CI -0.17–0.14). We found significantly lower EBL for RARC compared to OR C (MD -312.61, 95% CI -447 to -178.22) at the expense of significantly prolonged ORT (MD 82.34 minutes, 95% CI 44.82–119.86). Network meta-analysis did not find significant differences in complications between hRARC and iRARC.

CONCLUSIONS: This meta-analysis confirms the equivalence of RARC and OR C with respect to oncological outcomes.

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Published

2022-10-25

How to Cite

Riveros, C., Ranganathan, S., Nipper, C., Lim, K., Brooks, M., Dursun, F., Miles, B. J., Goh, A. C., Desai, M., Klaasen, Z., Kulkarni, G. S., Wallis, C. J., & Satkunasivam, R. (2022). Open vs. robot-assisted radical cystectomy with extracorporeal or intracorporeal urinary diversion for bladder cancer: A pairwise meta-analysis of outcomes and a network meta-analysis of complications. Canadian Urological Association Journal, 17(3), E75–85. https://doi.org/10.5489/cuaj.8096

Issue

Section

Original Research