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., … 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

Vol. 17 No. 3 (2023): CUAJ March

Section

Original Research

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