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Robotic Assisted Radical Cystectomy with Extracorporeal Urinary Diversion Does Not Show a Benefit over Open Radical Cystectomy: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.
PLoS One 2016; 11(11):e0166221Plos

Abstract

BACKGROUND

The number of robotic assisted radical cystectomy (RARC) procedures is increasing despite the lack of Level I evidence showing any advantages over open radical cystectomy (ORC). However, several systematic reviews with meta-analyses including non-randomised studies, suggest an overall benefit for RARC compared to ORC. We performed a systematic review with meta-analysis of randomised controlled trials (RCTs) to evaluate the perioperative morbidity and efficacy of RARC compared to ORC in patients with bladder cancer.

METHODS

Literature searches of Medline/Pubmed, Embase, Web of Science and clinicaltrials.gov databases up to 10th March 2016 were performed. The inclusion criteria for eligible studies were RCTs which compared perioperative outcomes of ORC and RARC for bladder cancer. Primary objective was perioperative and histopathological outcomes of RARC versus ORC while the secondary objective was quality of life assessment (QoL), oncological outcomes and cost analysis.

RESULTS

Four RCTs (from 5 articles) met the inclusion criteria, with a total of 239 patients all with extracorporeal urinary diversion. Patient demographics and clinical characteristics of RARC and ORC patients were evenly matched. There was no significant difference between groups in perioperative morbidity, length of stay, positive surgical margin, lymph node yield and positive lymph node status. RARC group had significantly lower estimated blood loss (p<0.001) and wound complications (p = 0.03) but required significantly longer operating time (p<0.001). QoL was not measured uniformly across trials and cost analysis was reported in one RCTs. A test for heterogeneity did highlight differences across operating time of trials suggesting that surgeon experience may influence outcomes.

CONCLUSIONS

This study does not provide evidence to support a benefit for RARC compared to ORC. These results may not have inference for RARC with intracorporeal urinary diversion. Well-designed trials with appropriate endpoints conducted by equally experienced ORC and RARC surgeons will be needed to address this.

Authors+Show Affiliations

Division of Surgery and Interventional Science, University College London, London, United Kingdom. Department of Urology, University College London Hospital, London, United Kingdom.Division of Surgery and Interventional Science, University College London, London, United Kingdom. Department of Urology, University College London Hospital, London, United Kingdom.Department of Urology, Rush University Medical Center, Chicago, Illinois, United States of America.Division of Surgery and Interventional Science, University College London, London, United Kingdom. Department of Urology, University College London Hospital, London, United Kingdom.Division of Surgery and Interventional Science, University College London, London, United Kingdom.Division of Surgery and Interventional Science, University College London, London, United Kingdom. Department of Urology, University College London Hospital, London, United Kingdom.

Pub Type(s)

Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

27820855

Citation

Tan, Wei Shen, et al. "Robotic Assisted Radical Cystectomy With Extracorporeal Urinary Diversion Does Not Show a Benefit Over Open Radical Cystectomy: a Systematic Review and Meta-Analysis of Randomised Controlled Trials." PloS One, vol. 11, no. 11, 2016, pp. e0166221.
Tan WS, Khetrapal P, Tan WP, et al. Robotic Assisted Radical Cystectomy with Extracorporeal Urinary Diversion Does Not Show a Benefit over Open Radical Cystectomy: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. PLoS ONE. 2016;11(11):e0166221.
Tan, W. S., Khetrapal, P., Tan, W. P., Rodney, S., Chau, M., & Kelly, J. D. (2016). Robotic Assisted Radical Cystectomy with Extracorporeal Urinary Diversion Does Not Show a Benefit over Open Radical Cystectomy: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. PloS One, 11(11), pp. e0166221. doi:10.1371/journal.pone.0166221.
Tan WS, et al. Robotic Assisted Radical Cystectomy With Extracorporeal Urinary Diversion Does Not Show a Benefit Over Open Radical Cystectomy: a Systematic Review and Meta-Analysis of Randomised Controlled Trials. PLoS ONE. 2016;11(11):e0166221. PubMed PMID: 27820855.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Robotic Assisted Radical Cystectomy with Extracorporeal Urinary Diversion Does Not Show a Benefit over Open Radical Cystectomy: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. AU - Tan,Wei Shen, AU - Khetrapal,Pramit, AU - Tan,Wei Phin, AU - Rodney,Simon, AU - Chau,Marisa, AU - Kelly,John D, Y1 - 2016/11/07/ PY - 2016/06/20/received PY - 2016/10/25/accepted PY - 2016/11/8/entrez PY - 2016/11/8/pubmed PY - 2017/6/28/medline SP - e0166221 EP - e0166221 JF - PloS one JO - PLoS ONE VL - 11 IS - 11 N2 - BACKGROUND: The number of robotic assisted radical cystectomy (RARC) procedures is increasing despite the lack of Level I evidence showing any advantages over open radical cystectomy (ORC). However, several systematic reviews with meta-analyses including non-randomised studies, suggest an overall benefit for RARC compared to ORC. We performed a systematic review with meta-analysis of randomised controlled trials (RCTs) to evaluate the perioperative morbidity and efficacy of RARC compared to ORC in patients with bladder cancer. METHODS: Literature searches of Medline/Pubmed, Embase, Web of Science and clinicaltrials.gov databases up to 10th March 2016 were performed. The inclusion criteria for eligible studies were RCTs which compared perioperative outcomes of ORC and RARC for bladder cancer. Primary objective was perioperative and histopathological outcomes of RARC versus ORC while the secondary objective was quality of life assessment (QoL), oncological outcomes and cost analysis. RESULTS: Four RCTs (from 5 articles) met the inclusion criteria, with a total of 239 patients all with extracorporeal urinary diversion. Patient demographics and clinical characteristics of RARC and ORC patients were evenly matched. There was no significant difference between groups in perioperative morbidity, length of stay, positive surgical margin, lymph node yield and positive lymph node status. RARC group had significantly lower estimated blood loss (p<0.001) and wound complications (p = 0.03) but required significantly longer operating time (p<0.001). QoL was not measured uniformly across trials and cost analysis was reported in one RCTs. A test for heterogeneity did highlight differences across operating time of trials suggesting that surgeon experience may influence outcomes. CONCLUSIONS: This study does not provide evidence to support a benefit for RARC compared to ORC. These results may not have inference for RARC with intracorporeal urinary diversion. Well-designed trials with appropriate endpoints conducted by equally experienced ORC and RARC surgeons will be needed to address this. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/27820855/Robotic_Assisted_Radical_Cystectomy_with_Extracorporeal_Urinary_Diversion_Does_Not_Show_a_Benefit_over_Open_Radical_Cystectomy:_A_Systematic_Review_and_Meta_Analysis_of_Randomised_Controlled_Trials_ L2 - http://dx.plos.org/10.1371/journal.pone.0166221 DB - PRIME DP - Unbound Medicine ER -