Systematic review and meta-analysis of comparing open and robotic-assisted intracorporeal radical cystectomy: based on randomized controlled trials.

Abstract

This study aims to compare perioperative outcomes between robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC) using totally intracorporeal urinary diversion. We systematically searched PubMed, Web of Science, Cochrane Library, and SpringerLink for randomized controlled trials (RCTs) comparing RARC and ORC until September 2, 2025. Data on operative time, estimated blood loss (EBL), hospital stay length (LOS), lymph node yield, positive surgical margin (PSM) rates, and complication rates at 30 and 90 days were extracted and pooled. A meta-analysis of four RCTs involving 523 patients showed that RARC was associated with a significantly longer operative time (WMD -74.36 min, p < 0.05). However, there were no statistically significant differences between RARC and ORC in EBL, hospital stay, lymph node yield, PSM rates, or the incidence of major and overall complications at both 30-day and 90-day intervals. As the first comparative study focusing exclusively on totally intracorporeal urinary diversion, this analysis demonstrates that RARC, despite longer operative times, achieves perioperative outcomes comparable to ORC. This suggests RARC is a viable surgical alternative in this specific setting. However, these findings are preliminary and require validation through larger, multicenter RCTs with extended follow-up.