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  • Review Article
  • Published:

Contemporary evidence for robot-assisted radical cystectomy for treating bladder cancer

Key Points

  • Robot-assisted radical cystectomy (RARC) can now replicate open radical cystectomy (ORC) in terms of technical benchmarks and could have other unique advantages

  • RARC is associated with less blood loss than ORC, but evidence for decreased complications and shorter duration of inpatient stay is lacking

  • In the absence of long-term evidence from randomized controlled trials, surrogate markers and observational data seem to show comparable oncological outcomes for RARC and ORC

  • Health-related quality of life outcomes seem comparable for RARC and ORC; however, detailed assessment of continence needs to be conducted

  • Outcomes must be scrutinized with regards to the cost of performing robotic surgery in order to support value-based adoption of RARC

  • Assessing the benefit of completely intracorporeal RARC compared with ORC is necessary, as all randomized controlled trials investigating RARC to date have involved extracorporeal diversion

Abstract

Robot-assisted radical cystectomy (RARC) is an evolving technique for the treatment of muscle-invasive bladder cancer (MIBC); however, its effectiveness compared with open radical cystectomy (ORC) — the established modality — is debated. Six specific areas of evidence are critically important for supporting the continuing use of RARC for MIBC, including technical aspects of surgery, perioperative outcomes, complications, oncological outcomes, functional outcomes, and financial costs. Considerable progress has been made regarding these aspects and data show that RARC replicates the technical benchmarks of ORC in terms of success of cystectomy, lymph node dissection, and urinary diversion, and could offer advantages over the more-established technique. Despite some clear benefits of RARC (such as reduced blood loss) other perioperative outcomes, including duration of inpatient stay and 30–90 day complication rates, seem to be similar to those of ORC. Current data on oncological and functional outcomes are promising, but robust data from prospective studies will help determine the indications for use of RARC for treating MIBC in the future.

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R.S. researched data for the article. R.S., CJ.D.W., R.K.N. and I.S.G. made substantial contributions to discussion of content. All authors wrote the article and reviewed and edited the manuscript before submission.

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Correspondence to Raj Satkunasivam.

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Satkunasivam, R., Wallis, C., Nam, R. et al. Contemporary evidence for robot-assisted radical cystectomy for treating bladder cancer. Nat Rev Urol 13, 533–539 (2016). https://doi.org/10.1038/nrurol.2016.139

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