Open Versus Robotic Radical Cystectomy With Intracorporeal Neobladder: A Decade-Long Single-Surgeon Experience.

Abstract

Introduction: This single-surgeon, long-term study aims to evaluate open radical cystectomy (ORC) and robot-assisted radical cystectomy (RARC) with Studer urinary diversion in bladder cancer patients in terms of perioperative, oncological, and functional outcomes.

Methods: This was a single-center, single-surgeon study analyzing patients who underwent open versus robotic intracorporeal neobladder (RIN) from January 2009 to January 2020. We recorded baseline characteristics, perioperative variables, outcomes, including cancer-specific survival (CSS) and overall survival (OS), and functional outcomes.

Results: The study included 454 patients (242 open, 212 robotic) with an overall follow-up of 120 months. The RIN group had significantly lower blood loss (p < 0.001), more unilateral nerve sparing (p = 0.008), and higher lymph node yield (p = 0.042). The number of 30-day readmissions favored RIN significantly (p = 0.041). Complication rates (major and minor) were similar between groups (p = 0.56 and 0.61, respectively). The RIN group had improved severe daytime continence (p = 0.03), though no significant difference was found in erectile function (p = 0.56). The robotic cohort showed improved 10-year CSS in T3 disease (68.3% vs. 50.5%, p = 0.04). The OS for the entire cohort was 66.5% for the robotic cohort and 61.6% for open at 10 years (p = 0.08).

Conclusions: In this series, RIN had decreased blood loss, an increased lymph node yield, decreased rate of hospital readmissions, lesser hospital stay, and improved severe daytime continence compared to the open approach.