Perioperative and Oncologic Outcomes of Robot-assisted Versus Laparoscopic Radical Cystectomy in Patients With Bladder Cancer.

Background/aim: Few studies have verified the relationship between treatment outcomes of robot-assisted radical cystectomy (RARC) and laparoscopic radical cystectomy (LRC). This study aimed to compare the perioperative and oncologic outcomes between RARC and LRC.

Patients and methods: Medical records of 75 patients (45 RARC and 30 LRC) who underwent radical cystectomy and standard or higher lymph node dissection between April 2013 and December 2019 at the Tottori University and other satellite hospitals were reviewed.

Results: The operative time was shorter in the LRC group. Mean estimated blood loss was lower in the RARC group. No differences were noted in the complication rates. The mean number of lymph nodes removed was 23.1 in the RARC group and 13.9 in the LRC group (p<0.001). Cox proportional hazards regression analysis showed that the tumor variant of the transurethrally resected bladder tumor (TUR-BT) tissue (p=0.032) and lymph node metastasis (p= 0.041) were significantly associated with a higher risk of cancer-specific survival (CSS). No difference in the CSS (p= 0.337) and recurrence-free survival (p=0.448) was found in all patients having either RARC or LRC. However, the CSS of RARC was higher than that of LRC (p=0.032) in patients with locally advanced stages of bladder cancer such as pathological T stage ≥3 or pathological lymph node positivity.

Conclusion: In patients with locally advanced bladder cancer pathological T stage ≥3 or pathological lymph node positivity, LRC appears to be associated with shorter CSS than RARC.