RARC Pasadena Consensus Panel – ReviewEditorial by Monish Aron and Inderbir S. Gill on pp. 361–362 of this issueSystematic Review and Cumulative Analysis of Perioperative Outcomes and Complications After Robot-assisted Radical Cystectomy
Introduction
Radical cystectomy (RC) with regional lymph node dissection is the standard surgical treatment for muscle-invasive and high-risk non–muscle-invasive urothelial carcinoma of the bladder [1]. Although open RC (ORC) is still the most commonly adopted surgical approach [2], minimally invasive techniques have gained popularity such that laparoscopic RC (LRC) and robot-assisted RC (RARC) are routinely performed with promising short- and intermediate-term results [3].
Due to increasing evidence in the field of RARC and in preparation for the Pasadena international consensus meeting on best practice in RARC and urinary diversion, we performed a systematic literature review of perioperative, functional, and oncologic outcomes of RARC in comparison with ORC and LRC. We report the findings of this review with a cumulative analysis of perioperative outcomes and postoperative complications.
Section snippets
Evidence acquisition
The systematic literature search was initially performed in September 2013 using the Medline, Scopus, and Web of Science databases. The searches included a free-text protocol using the terms robot-assisted radical cystectomy or da Vinci radical cystectomy or robot* radical cystectomy in all fields of the records for PubMed and Scopus searches and in the Title and Topic fields for the Web of Science search. No limits were applied. A full update of the searches was done April 28, 2014.
Two authors
Quality of the studies and level of evidence
The flow of this systematic review of the literature is shown in Fig. 1. In total, 70 surgical series [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37], [38], [39], [40], [41], [42], [43], [44], [45], [46], [47], [48], [49], [50], [51], [52], [53], [54], [55], [56], [57], [58], [59], [60], [61], [62], [63], [64], [65], [66], [67], [68], [69], [70], [71], [72], [73], [74]
Conclusions
RARC can be performed safely with acceptable operative time, little blood loss, and low transfusion rates. The risk of intraoperative complications is low, but postoperative complications and readmission after discharge are common. Cumulative analyses demonstrated that operative time was shorter with ORC, whereas blood loss and transfusion rates were significantly lower with RARC than with ORC. Conversely, rates for any-grade and grade 3 complications at 90 d were slightly lower with RARC than
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Contributed equally.