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 Journal Article


Authors: Riveros, C.; Ranganathan, S.; Nipper, C.; Lim, K.; Brooks, M.; Dursun, F.; Miles, B. J.; Goh, A. C.; Desai, M.; Klaassen, Z.; Kulkarni, G. S.; Wallis, C. J. D.; Satkunasivam, R.
Article Title: 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
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. © 2023 Canadian Urological Association. All rights reserved.
Journal Title: CUAJ-Canadian Urological Association Journal
Volume: 17
Issue: 3
ISSN: 1911-6470
Publisher: Canadian Urological Association  
Date Published: 2023-03-01
Language: English
DOI: 10.5489/cuaj.8096
PROVIDER: scopus
PUBMED: 36473475
PMCID: PMC10027355
DOI/URL:
Notes: Article -- Export Date: 1 December 2022 -- Source: Scopus
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  1. Alvin Chun chin Goh
    72 Goh