Robotic Versus Open Radical Cystectomy: Identification of Patients who Benefit from the Robotic Approach

Abstract

PURPOSE: To identify patients who would benefit from robot-assisted radical cystectomy (RARC), we report perioperative outcomes and complications. PATIENTS AND METHODS: We compared patients who underwent RARC to patients who underwent open cystectomy (OC) in our institution. Data included demographics, operative variables, and recovery. Complications were grouped into early (<30 days), intermediate (31-90 days), and late (>90 days). RESULTS: There were 58 patients in the RARC group and 84 patients in the OC group. The mean age was 66 ± 1.2 years in the RARC v 67 ± 1.2 in OC (p=0.53) group. Women constituted 21% in the RARC and 30% in OC (p=0.23) group. The mean American Society of Anesthesiologists scores were 2.9 for the RARC and 2.94 for OC (p=0.5). The mean operative time for RARC was 7.8 ± 1.5 hours v 6.6 ± 1.25 hours for OC (p<0.0001). Estimated blood loss was 276 ± 48 mL in RARC v 1522 ± 369 mL in OC (p<0.0001). Positive margin rate was 7% in RARC v 8% in OC (p=0.8). Early complications of any severity (Clavien scores) occurred in 43% in RARC and 64% in OC (p=0.02). There was one mortality in RARC and two mortalities in OC. Patients were grouped by age (≥ 70- and <70-years old). The older group consisted of 19 and 44 patients in RARC and OC, respectively. Both age groups in RARC had less early complications than OC patients (p<0.014). The older group in RARC had less early complication rate (17%) than the younger group in OC (59%). CONCLUSIONS: RARC has improved perioperative outcomes with equivalent oncological parameters when compared to open cystectomy. Patients ≥ 70-years old benefit from the robotic approach, particularly when compared to younger patients undergoing open cystectomy.