Abstract
Introduction
We aimed to compare short term outcomes after robot assisted radical cystectomy (RARC)
and open radical cystectomy (ORC) for urinary bladder cancer in a large population.
Materials and methods
We included all patients without distant metastases who underwent either RARC or ORC
with ileal conduit between 2011 and 2019 registered in the Bladder cancer data Base
Sweden (BladderBaSe) 2.0. Primary outcome was unplanned readmissions within 90 days,
and secondary outcomes within 90 days of surgery were reoperations, Clavien 3–5 complications,
total days alive and out of hospital, and mortality. The analysis was carried out
using multivariate regression models.
Results
Out of 2905 patients, 832 were operated with RARC and 2073 with ORC. Robotic procedures
were to a larger extent performed during later years, at high volume centers (47%
vs 17%), more often for organ-confined disease (82% vs. 72%) and more frequently in
patients with high socioeconomic status (26% vs. 21%). Patients operated with RARC
were more commonly readmitted (29% vs. 25%). In multivariable analysis RARC was associated
with decreased risk of Clavien 3–5 complications (OR 0.58, 95% CI 0.47–0.72), reoperations
(OR 0.53, 95% CI 0.39–0.71) and had more days alive and out of hospital (mean difference
3.7 days, 95% CI 2.4–5.0).
Conclusion
This study illustrates the “real-world” effects of a gradual and nation-wide introduction
of RARC. Patients operated with RARC had fewer major complications and reoperations
but were more frequently readmitted compared to ORC. The observed differences were
largely due to more wound related complications among patients treated with ORC.
Keywords
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References
- Randomized trial comparing open radical cystectomy and robot-assisted laparoscopic radical cystectomy: oncologic outcomes.Eur Urol. 2018; 74: 465-471
- A single-centre early phase randomised controlled three-arm trial of open, robotic, and laparoscopic radical cystectomy (CORAL).Eur Urol. 2016; 69: 613-621
- Prospective randomized controlled trial of robotic versus open radical cystectomy for bladder cancer: perioperative and pathologic results.Eur Urol. 2010; 57: 196-201
- Robot-assisted radical cystectomy versus open radical cystectomy in patients with bladder cancer (RAZOR): an open-label, randomised, phase 3, non-inferiority trial.Lancet (London, England). 2018; 391: 2525-2536
- Effect of robot-assisted radical cystectomy with intracorporeal urinary diversion vs open radical cystectomy on 90-day morbidity and mortality among patients with bladder cancer: a randomized clinical trial.JAMA. 2022;
- No differences in population-based readmissions after open and robotic-assisted radical cystectomy: implications for post-discharge care.Urology. 2017; 104: 77-83
- National comparison of oncologic quality indicators between open and robotic-assisted radical cystectomy.Urol Oncol. 2016; 34: 431 e439-e431 e415
- Patient-reported convalescence and quality of life recovery: a comparison of open and robotic-assisted radical cystectomy.Surg Innovat. 2016; 23: 598-605
- Perioperative and oncologic outcomes of robot-assisted vs. open radical cystectomy in bladder cancer patients: a comparison of two high-volume referral centers.Eur J Surg Oncol. 2016; 42: 1736-1743
- Recurrence patterns after open and robot-assisted radical cystectomy for bladder cancer.Eur Urol. 2015; 68: 399-405
- Comparison of early postoperative morbidity after robot-assisted and open radical cystectomy: results of a prospective observational study.BJU Int. 2014; 113: 458-467
- Early oncologic outcomes of robotic vs. open radical cystectomy for urothelial cancer.Urol Oncol. 2013; 31: 894-898
- Matched comparison of robotic-assisted and open radical cystectomy.Urology. 2012; 79: 1303-1308
- A comparison of postoperative complications in open versus robotic cystectomy.Eur Urol. 2010; 57: 274-281
- Comparison of perioperative outcomes between open and robotic radical cystectomy: a population-based analysis.J Endourol. 2018; 32: 701-709
- Association of open vs robot-assisted radical cystectomy with mortality and perioperative outcomes among patients with bladder cancer in Sweden.JAMA Netw Open. 2022; 5e228959
- Cohort profile: the Swedish national register of urinary bladder cancer (SNRUBC) and the bladder cancer data Base Sweden (BladderBaSe).BMJ Open. 2017; 7e016606
- Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey.Ann Surg. 2004; 240: 205-213
- Days alive and out of hospital: validation of a patient-centered outcome for perioperative medicine.Anesthesiology. 2019; 131: 84-93
- Morbidity and days alive and out of hospital within 90 Days following radical cystectomy for bladder cancer.Eur Urol Open Sci. 2021; 28: 1-8
- Population-based estimates of age and comorbidity specific life expectancy: a first application in Swedish males.BMC Med Inf Decis Making. 2022; 22: 35
- Flexible imputation of missing data.CRC Press, Boca Raton, FL2012
- The optimal length of stay associated with the lowest readmission risk following surgery.J Surg Res. 2019; 239: 292-299
- Period-specific mean annual hospital volume of radical cystectomy is associated with outcome and perioperative quality of care: a nationwide population-based study.BJU Int. 2019; 124: 449-456
- Open radical cystectomy versus robot-assisted radical cystectomy with intracorporeal urinary diversion: early outcomes of a single-center randomized controlled trial.J Urol. 2022; 207: 982-992
- Systematic review: the learning curve for robot-assisted radical cystectomy-what do we know?.J Endourol. 2022;
- Closure methods for laparotomy incisions for preventing incisional hernias and other wound complications.Cochrane Database Syst Rev. 2017; 11: CD005661
- European Hernia Society guidelines on the closure of abdominal wall incisions.Hernia. 2015; 19: 1-24
- Patient-reported outcome after radical cystectomy: translation and psychometric validation of the Swedish version of the functional assessment of cancer Therapy scale Vanderbilt cystectomy index.Scand J Urol. 2016; 50: 374-379
- Robot-assisted radical cystectomy with intracorporeal urinary diversion in patients with transitional cell carcinoma of the bladder.Eur Urol. 2011; 60: 1066-1073
Article info
Publication history
Accepted:
January 23,
2023
Received in revised form:
January 11,
2023
Received:
November 9,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Published by Elsevier Ltd.