Monday, July 15, 2024

Comparative Analysis of Open vs. Robot-Assisted Radical Cystectomy

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Amid ongoing debates in the surgical community, a new systematic review and meta-analysis has shed light on the comparative effectiveness between open radical cystectomy (ORC) and robot-assisted radical cystectomy (RARC). This comprehensive study scrutinized randomized controlled trials (RCTs) to provide a clearer understanding of the health-related outcomes associated with these two surgical techniques for bladder cancer treatment.

Quality of Life and Complications

The primary focus of the study was to examine the health-related quality of life (QoL) of patients at 3 and 6 months post-surgery. Data was meticulously gathered from PubMed/Medline, Web of Science, and Embase, following PRISMA guidelines, up to March 2024. Eight RCTs were selected, encompassing a total of 1024 patients, divided almost equally between those undergoing RARC (515) and ORC (509). Results indicated that QoL was similar in both groups at both time intervals. Furthermore, no significant differences were observed in terms of overall and major complications at both 30 and 90 days post-surgery.

Pathological and Oncological Outcomes

When evaluating pathological and perioperative outcomes, the study found no significant disparities in oncological results between the two surgical approaches. However, RARC was associated with a notably longer operative time, with a mean difference of 92.34 minutes. Conversely, the transfusion rate was significantly lower in the RARC group, highlighting a critical advantage of the robotic procedure.

From a market access perspective, these findings are pivotal. The reduced transfusion rate and comparable QoL outcomes suggest that RARC could be a more favorable option despite its higher initial costs and longer operative time. These factors could influence healthcare providers and policymakers in their decision-making process regarding the adoption and reimbursement of advanced robotic surgical systems.

Cost Evaluation Insights

– The cost evaluation conducted as part of the study revealed that while RARC has higher operational expenses, these are potentially offset by the lower transfusion rates and subsequent healthcare savings.
– The prolonged operative time associated with RARC might necessitate adjustments in surgical scheduling and resource allocation, impacting hospital operations and overall patient throughput.
– The comparable QoL outcomes between RARC and ORC at 3 and 6 months post-surgery suggest that the higher costs of RARC could be justified by its clinical benefits, particularly in reducing postoperative transfusions.

In conclusion, both ORC and RARC are viable surgical options for bladder cancer, offering similar complication rates and oncological outcomes. The choice between these methods should consider factors such as operative time, transfusion rates, and overall costs. This study provides valuable insights that could influence surgical practice and healthcare policy, emphasizing the need for balanced decision-making in the adoption of advanced surgical technologies.

Original Article:

J Robot Surg. 2024 Jul 3;18(1):277. doi: 10.1007/s11701-024-02026-1.

ABSTRACT

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Several randomized control trials (RCTs) have been published comparing open (ORC) with robot-assisted radical cystectomy (RARC). However, uncertainty persists regarding this issue, as evidences and recommendations on RARC are still lacking. In this systematic review and metaanalysis, we summarized evidence in this context. A literature search was conducted according to PRISMA criteria, using PubMed/Medline, Web Of Science and Embase, up to March 2024. Only randomized controlled trials (RCTs) were selected. The primary endpoint was to investigate health-related quality of life (QoL) both at 3 and 6 months after surgery. Secondary endpoints include pathological and perioperative outcomes, postoperative complications and oncological outcomes. Furthermore, we conducted a cost evaluation based on the available evidence. Eight RCTs were included, encompassing 1024 patients (515 RARC versus 509 ORC). QoL appeared similar among the two groups both after 3 and 6 months. No significant differences in overall and major complications at 30 days (p = 0.11 and p > 0.9, respectively) and 90 days (p = 0.28 and p = 0.57, respectively) were observed, as well as in oncological, pathological and perioperative outcomes, excepting from operative time, which was longer in RARC (MD 92.34 min, 95% CI 83.83-100.84, p < 0.001) and transfusion rate, which was lower in RARC (OR 0.43, 95% CI 0.30-0.61, p < 0.001). Both ORC and RARC are viable options for bladder cancer, having comparable complication rates and oncological outcomes. RARC provides transfusion rate advantages, however, it has longer operative time and higher costs. QoL outcomes appear similar between the two groups, both after 3 and 6 months.

PMID:38961035 | DOI:10.1007/s11701-024-02026-1

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