Robot-assisted and open radical cystectomy for bladder cancer do not differ with regard to complication rates and health-related quality of life (HRQOL), according to the findings of a recent prospective comparative effectiveness study.

The study, by Carl J. Wijburg, MD, of Rijnstate Hospital in Arnhem, The Netherlands, and colleagues, included 348 patients enrolled at 19 centers. Of these patients, 168 and 180 underwent open radical cystectomy (ORC) and robot-assisted radical cystectomy (RARC), respectively. The any-grade complication rate at 90 days — the study’s primary outcome — was 63% in the ORC group and 56% in the RARC group, Dr Wijburg and colleagues reported online in European Urology. Rates of major complications were 15% and 16%, respectively, and rates of minor complications were 57% and 49%, respectively. The between-group differences did not differ significantly.

Using 2 patient-reported HRQOL measures—the Functional Assessment of Cancer Therapy-Bladder Cystectomy and the Bladder Cancer Index—the investigators found no significant differences in HRQOL. They also found no significant differences in pathologic T stage, mortality, and disease recurrence rates.

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Compared with RARC recipients, however, the ORC group had a significantly higher median estimated blood loss, shorter median total operating room time, longer median hospital length of stay, and more intensive care unit admissions, according to the investigators. In addition, positive surgical margins occurred significantly more frequently in the ORC group.

“The clinical implications of this comparative effectiveness study are unclear as we do not foresee that RARC urologists will return to ORC,” the authors wrote. “A reason for the use of RARC to remain in clinical practice is that many urologists are nowadays trained mainly in minimally invasive techniques (also for other indications than cystectomy), and as laparoscopic cystectomy is challenging, RARC might be the only minimally invasive alternative.”


Wijburg CJ, Michels CTJ, Grutters JPC, et al. Robot-assisted radical cystectomy versus open radical cystectomy in bladder cancer patients: A multicentre comparative effectiveness study. Published online January 11, 2021. Eur Urol. doi:10.1016/j.eururo.2020.12.023