Oncologic outcomes after robot-assisted versus open radical cystectomy: a systematic review and meta-analysis

Takehiro Iwata, Shoji Kimura, Beat Foerster, Nicola Fossati, Alberto Briganti, Pierre I. Karakiewicz, Kilian M. Gust, Shin Egawa, Yasutomo Nasu, Mohammad Abufaraj, Shahrokh F. Shariat

Research output: Contribution to journalReview article

Abstract

Purpose: The efficacy of RARC in oncologic outcomes compared ORC is controversial. We assess potential differences in oncologic outcomes between robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC). Methods: We performed the literature search systematically according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. A pooled meta-analysis was performed to assess the difference in oncologic outcomes between RARC and ORC, separately in randomized controlled trials (RCTs) and non-randomized studies (NRCTs). Results: Five RCTs and 28 NRCTs were included in this systematic review and meta-analysis. There was no difference in the rate of overall positive surgical margin (PSM) in RCTs, while NRCTs showed a lower rate for RARC. There was no difference in the soft tissue PSM rate between RARC and ORC in both RCTs and NRCTs. There was no difference in the lymph node yield by standard and extended lymph node dissection between RARC and ORC in both RCTs and NRCTs. There was no significant difference in survival outcomes between RARC and ORC in both RCTs and NRCTs. Conclusions: Based on the current evidence, there is no difference in the rate of PSMs, lymph node yield, recurrence rate and location as well as short-term survival outcomes between RARC and ORC in RCTs. In NRCTs, only PSM rates were better for RARC compared to ORC, but this was likely due to selection and reporting bias which are inherent to retrospective study designs.

Original languageEnglish
Pages (from-to)1557-1570
Number of pages14
JournalWorld Journal of Urology
Volume37
Issue number8
DOIs
Publication statusPublished - Aug 1 2019

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Cystectomy
Meta-Analysis
Randomized Controlled Trials
Lymph Nodes
Selection Bias
Lymph Node Excision

Keywords

  • Oncologic outcome
  • Open radical cystectomy
  • Positive surgical margin
  • Robot-assisted radical cystectomy

ASJC Scopus subject areas

  • Urology

Cite this

Iwata, T., Kimura, S., Foerster, B., Fossati, N., Briganti, A., Karakiewicz, P. I., ... Shariat, S. F. (2019). Oncologic outcomes after robot-assisted versus open radical cystectomy: a systematic review and meta-analysis. World Journal of Urology, 37(8), 1557-1570. https://doi.org/10.1007/s00345-019-02708-8

Oncologic outcomes after robot-assisted versus open radical cystectomy : a systematic review and meta-analysis. / Iwata, Takehiro; Kimura, Shoji; Foerster, Beat; Fossati, Nicola; Briganti, Alberto; Karakiewicz, Pierre I.; Gust, Kilian M.; Egawa, Shin; Nasu, Yasutomo; Abufaraj, Mohammad; Shariat, Shahrokh F.

In: World Journal of Urology, Vol. 37, No. 8, 01.08.2019, p. 1557-1570.

Research output: Contribution to journalReview article

Iwata, T, Kimura, S, Foerster, B, Fossati, N, Briganti, A, Karakiewicz, PI, Gust, KM, Egawa, S, Nasu, Y, Abufaraj, M & Shariat, SF 2019, 'Oncologic outcomes after robot-assisted versus open radical cystectomy: a systematic review and meta-analysis', World Journal of Urology, vol. 37, no. 8, pp. 1557-1570. https://doi.org/10.1007/s00345-019-02708-8
Iwata, Takehiro ; Kimura, Shoji ; Foerster, Beat ; Fossati, Nicola ; Briganti, Alberto ; Karakiewicz, Pierre I. ; Gust, Kilian M. ; Egawa, Shin ; Nasu, Yasutomo ; Abufaraj, Mohammad ; Shariat, Shahrokh F. / Oncologic outcomes after robot-assisted versus open radical cystectomy : a systematic review and meta-analysis. In: World Journal of Urology. 2019 ; Vol. 37, No. 8. pp. 1557-1570.
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T2 - a systematic review and meta-analysis

AU - Iwata, Takehiro

AU - Kimura, Shoji

AU - Foerster, Beat

AU - Fossati, Nicola

AU - Briganti, Alberto

AU - Karakiewicz, Pierre I.

AU - Gust, Kilian M.

AU - Egawa, Shin

AU - Nasu, Yasutomo

AU - Abufaraj, Mohammad

AU - Shariat, Shahrokh F.

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N2 - Purpose: The efficacy of RARC in oncologic outcomes compared ORC is controversial. We assess potential differences in oncologic outcomes between robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC). Methods: We performed the literature search systematically according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. A pooled meta-analysis was performed to assess the difference in oncologic outcomes between RARC and ORC, separately in randomized controlled trials (RCTs) and non-randomized studies (NRCTs). Results: Five RCTs and 28 NRCTs were included in this systematic review and meta-analysis. There was no difference in the rate of overall positive surgical margin (PSM) in RCTs, while NRCTs showed a lower rate for RARC. There was no difference in the soft tissue PSM rate between RARC and ORC in both RCTs and NRCTs. There was no difference in the lymph node yield by standard and extended lymph node dissection between RARC and ORC in both RCTs and NRCTs. There was no significant difference in survival outcomes between RARC and ORC in both RCTs and NRCTs. Conclusions: Based on the current evidence, there is no difference in the rate of PSMs, lymph node yield, recurrence rate and location as well as short-term survival outcomes between RARC and ORC in RCTs. In NRCTs, only PSM rates were better for RARC compared to ORC, but this was likely due to selection and reporting bias which are inherent to retrospective study designs.

AB - Purpose: The efficacy of RARC in oncologic outcomes compared ORC is controversial. We assess potential differences in oncologic outcomes between robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC). Methods: We performed the literature search systematically according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. A pooled meta-analysis was performed to assess the difference in oncologic outcomes between RARC and ORC, separately in randomized controlled trials (RCTs) and non-randomized studies (NRCTs). Results: Five RCTs and 28 NRCTs were included in this systematic review and meta-analysis. There was no difference in the rate of overall positive surgical margin (PSM) in RCTs, while NRCTs showed a lower rate for RARC. There was no difference in the soft tissue PSM rate between RARC and ORC in both RCTs and NRCTs. There was no difference in the lymph node yield by standard and extended lymph node dissection between RARC and ORC in both RCTs and NRCTs. There was no significant difference in survival outcomes between RARC and ORC in both RCTs and NRCTs. Conclusions: Based on the current evidence, there is no difference in the rate of PSMs, lymph node yield, recurrence rate and location as well as short-term survival outcomes between RARC and ORC in RCTs. In NRCTs, only PSM rates were better for RARC compared to ORC, but this was likely due to selection and reporting bias which are inherent to retrospective study designs.

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KW - Open radical cystectomy

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