Open vs. robot-assisted radical cystectomy with extracorporeal or intracorporeal urinary diversion for bladder cancer: A pairwise meta-analysis of outcomes and a network meta-analysis of complications by urinary diversion approach

Carlos Riveros, Sanjana Ranganathan, Cole Nipper, Kelvin Lim, Michael Brooks, Furkan Dursun, Brian J. Miles, Alvin C. Goh, Mihir Desai, Zachary Klaassen, Girish S. Kulkarni, Christopher J.D. Wallis, Raj Satkunasivam

Research output: Contribution to journalArticlepeer-review

Abstract

Introduction: There are no meta-analyses of randomized controlled trials (RCTs) comparing open radical cystectomy (ORC) with robot-assisted radical cystectomy (RARC), inclusive of both intracorporeal (iRARC) and extracorporeal (hybrid RARC, hRARC) urinary reconstruction. Methods: MEDLINE, Embase, Scopus, the International Clinical Trials Registry Platform and ClinicalTrials.gov registries were searched in May 2022. Outcomes of interest included recurrence- or progression-free survival (RFS/PFS), margin status and lymph node yield, mean estimated blood loss (EBL) and operating room time (ORT), hospital length of stay (LOS), 90-day complications and readmissions, and quality of life (QoL). Pairwise meta-analyses and network meta-analyses were performed using random-effects models and Bayesian hierarchical random-effects models, respectively. Results: We found no significant differences between RARC and ORC for oncological and most perioperative outcomes: RFS/PFS (hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.67–1.23); positive surgical margins (odds ratio [OR] 1.05, 95% CI 0.60–1.85); lymph node yield (mean difference [MD] -0.63, 95% CI -2.63–1.37); LOS (MD -0.22, 95% CI -1.10–0.65); overall complications (OR 0.81, 95% CI 0.61–1.07); major complications (OR 0.94, 95% CI 0.69–1.30); readmissions (OR 0.90, 95% CI 0.60–1.35); and QoL (standardized MD -0.02, 95% CI -0.17–0.14). We found significantly lower EBL for RARC compared to ORC (MD -312.61, 95% CI - 447 to -178.22) at the expense of significantly prolonged ORT (MD 82.34 minutes, 95% CI 44.82–119.86). Network meta-analysis did not find significant differences in complications between hRARC and iRARC. Conclusions: This meta-analysis confirms the equivalence of RARC and ORC with respect to oncological outcomes.

Original languageEnglish (US)
JournalJournal of the Canadian Urological Association
Volume17
Issue number3
DOIs
StatePublished - Mar 2023

ASJC Scopus subject areas

  • Urology

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