A Cochrane review of available evidence has concluded that clinical outcomes are similar with robotic and open radical cystectomy for bladder cancer.
Based on the findings of five randomised controlled trials involving 541 participants, the review authors found very little difference in time to recurrence with the robotic vs open technique (HR, 1.05; 95% CI, 0.77-1.43; 2 trials; low-certainty evidence).
The risk for major complication (Clavien grades 3 to 5) was also comparable between the groups (risk ratio [RR], 1.06; 95% CI, 0.76-1.48; 5 trials; low-certainty evidence). There was considerable uncertainty about the effects on minor complications (Clavien grades 1 and 2), with only very low-certainty evidence available. Quality of life and the risk for positive margins were similar with both techniques.
However, the authors concluded that robotic cystectomy “probably results in substantially fewer transfusions than open cystectomy” (RR, 0.58; 95% CI, 0.43-0.80; 2 trials; moderate-certainty evidence). Robotic cystectomy may also result in a slightly shorter hospital stay (mean difference, −0.67; 95% CI, −1.22 to −0.12; 5 trials; low-certainty evidence).
The authors were unable to conduct any of the preplanned subgroup analyses to assess the impact of patient age, pathological stage or surgeon expertise and did not address cost‐effectiveness.
