Robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC) for muscle-invasive or high-risk non-muscle invasive bladder cancer are associated with similar outcomes, but RARC might have some advantages, a new literature review suggests.

Kyrollis Attalla, MD, and colleagues of Icahn School of Medicine at Mount Sinai in New York analyzed data from randomized, prospective, and retrospective studies comparing open radical cystectomy (ORC) with RARC published in the last 5 years. Results from the 3 randomized trials showed RARC to be non-inferior to ORC, the investigators reported in Future Oncology 2017;13:1195-1204). In addition, RARC appeared to result in less estimated blood loss, fewer transfusion requirements, shorter length of stay, and lower analgesic use.

Oncologic outcomes, long-term complications, and health-related quality of life appeared similar between surgical groups, based on observational studies. Limited evidence with respect to extracorporeal versus intracorporeal urinary diversion following RARC suggested that the intracorporeal approach might be favorable.

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Larger studies with longer follow-up are needed to further assess robotic versus open approaches to RC. “Robotic surgery has become the preferred technique among many urologists in the management of urologic cancers,” Dr Attalla told Renal & Urology News. “Although ample comparisons between open versus robotic renal and prostate surgery exist in the literature, the same comparisons in bladder cancer surgery are less robust.”

Dr Attalla’s team speculates that there will be a continued increase in robotic procedures performed at high volume centers and as overall surgeon experience increases.

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Attalla K, Kent M, Waingankar N, Mehrazin R. Robotic-assisted radical cystectomy versus open radical cystectomy for management of bladder cancer: review of literature and randomized trials. Future Oncol. 2017 Jun;13(13):1195-1204. doi: 10.2217/fon-2017-0004. [Epub ahead of print]