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JU INSIGHT Open Radical Cystectomy versus Robot-Assisted Radical Cystectomy with Intracorporeal Urinary Diversion: Early Outcomes of a Single-Center Randomized Controlled Trial
By: Riccardo Mastroianni, MD; Mariaconsiglia Ferriero, MD, PhD; Gabriele Tuderti, MD, PhD; Umberto Anceschi, MD, PhD; Alfredo Maria Bove, MD; Aldo Brassetti, MD; Leonardo Misuraca, MD, PhD; Ashanti Zampa; Giulia Torregiani, MD; Edoardo Ghiani; Diana Giannarelli; Salvatore Guaglianone, MD; Michele Gallucci, Prof.; Giuseppe Simone, MD, PhD | Posted on: 01 May 2022
Mastroianni R, Ferriero M, Tuderti G et al: Open radical cystectomy versus robot-assisted radical cystectomy with intracorporeal urinary diversion: early outcomes of a single-center randomized controlled trial. J Urol 2022; https://doi.org/10.1097/JU.0000000000002422.
Study Need and Importance
Robotic surgery is constantly expanding, particularly in urological surgery. However, even if a steady increase of the robotic approach was described in the surgical treatment of prostate and kidney cancer, a slower spread was reported in the treatment of bladder cancer. The intrinsic complexity of performing a totally intracorporeal urinary diversion (i-UD) and longer operative times were the main drivers against a widespread adoption of robot-assisted radical cystectomy (RARC). Despite acknowledged importance of attempting to perform i-UD following RARC, the extracorporeal urinary diversion accomplishment remains the most adopted approach. To date, all the available randomized controlled trials were characterized by an extracorporeal approach in performing urinary diversion, undermining potential benefits of a totally minimally invasive procedure. To the best of our knowledge, this is the first randomized controlled trial aimed at comparing open radical cystectomy (ORC) vs RARC with totally i-UD. The primary end point was to demonstrate the superiority of RARC with i-UD in terms of a 50% transfusions rate’s reduction.
What We Found
Our study confirmed significantly lower transfusions rates in the RARC cohort (22% vs 41%), confirming RARC with i-UD to be time consuming compared with ORC. More interestingly, peri- and postoperative complication rates were comparable between groups, highlighting feasibility and safety of a totally intracorporeal approach.
Limitations
The study was performed in a single high-volume referral center, and surgical procedures were performed by 2 expert surgical teams. Furthermore, the rates of neobladder are higher than those reported in general practice; therefore, results obtained may not be widely generalized.
Interpretation for Patient Care
This prospective randomized trial observed 22% and 41% overall perioperative transfusion rates in patients treated by RARC and ORC, respectively, confirming a significant benefit in favor of RARC with i-UD. However, perioperative complications, hospital stay and 6-month health-related quality of life were largely comparable between groups.