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Robotic or open radical cystectomy, which is safer?: a systematic review and meta-analysis of comparative studies

Robotic or open radical cystectomy, which is safer?: a systematic review and meta-analysis of comparative studies
Robotic or open radical cystectomy, which is safer?: a systematic review and meta-analysis of comparative studies

Objectives: To compare early surgical outcomes for RRC and open radical cystectomy (ORC) with an emphasis on complications and postoperative mortality rates.

Methods: Evidence Acquisition: A literature review was conducted from 2000 to 2013, including studies comparing RRC and ORC. The main outcome measures analyzed were the complications and mortality rates, in addition to patient demographics, pathological parameters, operating time, estimated blood loss (EBL), transfusion rates, and type of urinary diversion. A meta-analysis was conducted. For continuous data, the Mantel–Haenszel chi-square test was used, and for dichotomous data, inverse variance was used and each expressed as risk ratio with 95% CI.

Results: In total, 748 patients were included, 461 patients in the robotic group and 287 patients in the open group (seven studies). There were no significant differences in the demographic parameters of the two groups, except for age (age: p=0.03). There was no difference in the number of muscle-invasive diseases: p=0.47. No difference in positive surgical margin rates (p=0.21).

Primary Outcomes: The overall (p=0.32) and lower grade (Clavien I-II) (p=0.10) complication rates between the two cohorts did not achieve statistical significance. The high-grade (Clavien III-IV) (p=0.007) complication rates in the ORC group were significantly higher. The mortality rate (Clavien V) was higher in the ORC group (2.2%) compared with the RRC group (0.35%) and this did achieve statistical significance on a meta-analysis (p=0.04).

Secondary Outcomes: The EBL and transfusion rates were statistically significantly lower in the RRC cohort (p<0.00001). The operating time was statistically significantly higher in the RRC cohort (p<0.00001). There was no statistically significant difference in the margin positivity between the two cohorts (p=0.08).

Conclusion: In early experience, RRC appears to be feasible and a safe alternative to the ORC. RRC appears to have lower high-grade complications and mortality rates compared with the open approach. Although these results are promising, the authors would suggest caution while interpreting these results due to concerns with methodological flaws in the included studies in this review.

Aged, Blood Loss, Surgical, Blood Transfusion, Carcinoma, Transitional Cell, Cystectomy, Female, Humans, Male, Middle Aged, Operative Time, Postoperative Complications, Robotic Surgical Procedures, Safety, Treatment Outcome, Urinary Bladder Neoplasms, Urinary Diversion, Comparative Study, Journal Article, Meta-Analysis, Review
0892-7790
1215-1223
Ishii, Hiro
d2dd0ce3-0ccd-4cb4-8aa1-f6d363e29b90
Rai, Bhavan Prasad
e1156207-bfd1-4f89-b0aa-9e55fc54235b
Stolzenburg, Jens-Uwe
976738fc-ba4e-4d4a-a2ac-71e0ff327fb1
Bose, Pradeep
cf373625-c51e-4fbf-83bc-4c8a95dd9841
Chlosta, Piotr L
f15638f2-4870-42e8-a972-a179a7573cb5
Somani, Bhaskar K
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Nabi, Ghulam
20d3e635-ec9c-4b53-8703-f50b443196da
Qazi, Hasan Abdur Rahman
fc7a8c0b-4df0-4c0e-872f-a2a9264b8a9a
Rajbabu, Krishnamoorthy
9f4111ed-fe9a-4b38-adea-20ddb3c29b84
Kynaston, Howard
cc327bde-bf3b-4e32-9bdb-da36c76aa4f9
Aboumarzouk, Omar M
3c7e2433-638d-4378-9931-902fdc68acce
Ishii, Hiro
d2dd0ce3-0ccd-4cb4-8aa1-f6d363e29b90
Rai, Bhavan Prasad
e1156207-bfd1-4f89-b0aa-9e55fc54235b
Stolzenburg, Jens-Uwe
976738fc-ba4e-4d4a-a2ac-71e0ff327fb1
Bose, Pradeep
cf373625-c51e-4fbf-83bc-4c8a95dd9841
Chlosta, Piotr L
f15638f2-4870-42e8-a972-a179a7573cb5
Somani, Bhaskar K
ab5fd1ce-02df-4b88-b25e-8ece396335d9
Nabi, Ghulam
20d3e635-ec9c-4b53-8703-f50b443196da
Qazi, Hasan Abdur Rahman
fc7a8c0b-4df0-4c0e-872f-a2a9264b8a9a
Rajbabu, Krishnamoorthy
9f4111ed-fe9a-4b38-adea-20ddb3c29b84
Kynaston, Howard
cc327bde-bf3b-4e32-9bdb-da36c76aa4f9
Aboumarzouk, Omar M
3c7e2433-638d-4378-9931-902fdc68acce

Ishii, Hiro, Rai, Bhavan Prasad, Stolzenburg, Jens-Uwe, Bose, Pradeep, Chlosta, Piotr L, Somani, Bhaskar K, Nabi, Ghulam, Qazi, Hasan Abdur Rahman, Rajbabu, Krishnamoorthy, Kynaston, Howard and Aboumarzouk, Omar M (2014) Robotic or open radical cystectomy, which is safer?: a systematic review and meta-analysis of comparative studies. Journal of Endourology, 28 (10), 1215-1223. (doi:10.1089/end.2014.0033).

Record type: Review

Abstract

Objectives: To compare early surgical outcomes for RRC and open radical cystectomy (ORC) with an emphasis on complications and postoperative mortality rates.

Methods: Evidence Acquisition: A literature review was conducted from 2000 to 2013, including studies comparing RRC and ORC. The main outcome measures analyzed were the complications and mortality rates, in addition to patient demographics, pathological parameters, operating time, estimated blood loss (EBL), transfusion rates, and type of urinary diversion. A meta-analysis was conducted. For continuous data, the Mantel–Haenszel chi-square test was used, and for dichotomous data, inverse variance was used and each expressed as risk ratio with 95% CI.

Results: In total, 748 patients were included, 461 patients in the robotic group and 287 patients in the open group (seven studies). There were no significant differences in the demographic parameters of the two groups, except for age (age: p=0.03). There was no difference in the number of muscle-invasive diseases: p=0.47. No difference in positive surgical margin rates (p=0.21).

Primary Outcomes: The overall (p=0.32) and lower grade (Clavien I-II) (p=0.10) complication rates between the two cohorts did not achieve statistical significance. The high-grade (Clavien III-IV) (p=0.007) complication rates in the ORC group were significantly higher. The mortality rate (Clavien V) was higher in the ORC group (2.2%) compared with the RRC group (0.35%) and this did achieve statistical significance on a meta-analysis (p=0.04).

Secondary Outcomes: The EBL and transfusion rates were statistically significantly lower in the RRC cohort (p<0.00001). The operating time was statistically significantly higher in the RRC cohort (p<0.00001). There was no statistically significant difference in the margin positivity between the two cohorts (p=0.08).

Conclusion: In early experience, RRC appears to be feasible and a safe alternative to the ORC. RRC appears to have lower high-grade complications and mortality rates compared with the open approach. Although these results are promising, the authors would suggest caution while interpreting these results due to concerns with methodological flaws in the included studies in this review.

Full text not available from this repository.

More information

Published date: 2 October 2014
Keywords: Aged, Blood Loss, Surgical, Blood Transfusion, Carcinoma, Transitional Cell, Cystectomy, Female, Humans, Male, Middle Aged, Operative Time, Postoperative Complications, Robotic Surgical Procedures, Safety, Treatment Outcome, Urinary Bladder Neoplasms, Urinary Diversion, Comparative Study, Journal Article, Meta-Analysis, Review

Identifiers

Local EPrints ID: 419117
URI: https://eprints.soton.ac.uk/id/eprint/419117
ISSN: 0892-7790
PURE UUID: 311c5627-882f-4a4b-bcc4-c9399914bedd

Catalogue record

Date deposited: 05 Apr 2018 16:30
Last modified: 13 Mar 2019 18:44

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