In a Swedish population-based cohort study reported in JAMA Network Open, Mortezavi et al found that robot-assisted radical cystectomy with intracorporeal urinary diversion was associated with reduced all-cause mortality, reduced high-grade complications, and improved perioperative outcomes vs open radical cystectomy in patients with bladder cancer.
The study involved data from the Swedish National Register of Urinary Bladder Cancer and population-based Cause of Death Register on all patients who underwent radical cystectomy for bladder cancer between January 2011 and December 2018, with follow-up data collected through December 2019. Among 889 patients undergoing robot-assisted radical cystectomy and 2,280 undergoing open radical cystectomy, a propensity score–matched cohort of 874 robot-assisted radical cystectomy patients and 1,154 open radical cystectomy patients was used for analysis.
Key Findings
Median follow-up was 47 months (interquartile range = 28–71 months). Cancer-specific mortality rates were 27.6% (variance = 3.12%) in the robot-assisted radical cystectomy group vs 30.2% (variance = 1.59%) in the open radical cystectomy group at 5 years, and 30.3% (variance = 5.13%) vs 32.3% (variance = 1.91%) at 7 years (P = .16).
Overall survival rates were 61.4% (variance = 5.11%) vs 57.7% (variance = 2.46%) at 5 years, and 58.2% (variance = 7.33%) vs 51.2% (variance = 3.41%) at 7 years (P = .01). On multivariate analysis, robot-assisted radical cystectomy was associated with significantly improved overall survival (hazard ratio = 0.71, 95% confidence interval [CI] = 0.56–0.89, P = .004).
The 30-day all-cause mortality rate was 0.9% for robot-assisted radical cystectomy vs 1.5% for open radical cystectomy (odds ratio [OR] = 0.58, 95% CI = 0.15–2.28, P = .44) and the 90-day mortality rate was 2.7% vs 4.2% (OR = 0.70, 95% CI = 0.32–1.54, P = .38).
Compared with open radical cystectomy, robot-assisted radical cystectomy was associated with:
- Lower estimated blood loss (median = 150 vs 700 mL, P < .001)
- Lower intraoperative transfusion rate (7.7% vs 38.7%, OR = 0.05, 95% CI = 0.03–0.08, P < .001)
- Shorter hospital stay (median = 9 vs 13 days, P < .001)
- Higher lymph node yield (median = 20 vs 14 lymph nodes, P < .001)
- Lower rate of Clavien-Dindo grade III or higher complications (17.2% vs 23.9%, OR = 0.62, 95% CI = 0.43–0.87, P = .009).
However, robot-assisted radical cystectomy was associated with a higher 90-day rehospitalization rate vs open radical cystectomy (34.3% vs 26.1%, OR = 1.28, 95% CI = 1.02–1.60, P = .03).
The investigators concluded, “These findings suggest that compared with open radical cystectomy, robot-assisted radical cystectomy with intracorporeal urinary diversion was associated with a lower overall mortality rate, fewer high-grade complications, and more favorable perioperative outcomes.”
Ashkan Mortezavi, MD, of the Department of Urology, University Hospital Basel, is the corresponding author for the JAMA Network Open article.
Disclosure: For full disclosures of the study authors, visit jamanetwork.com.
