Comparative Effectiveness in Perioperative Outcomes of Robotic versus Open Radical Cystectomy: Results from a Multicenter Contemporary Retrospective Cohort Study

Autor: Marco Moschini, Romain Mathieu, Stephen A. Boorjian, Peter Wiklund, Shahrokh F. Shariat, Edward Rowe, Badrinath R. Konety, Matthew Perry, Guillaume Ploussard, K. Gust, Prasanna Sooriakumaran, Beat Foerster, Morgan Rouprêt, Mohammad Abufaraj, David D'Andrea, Paolo Gontero, Suprita Krishna, Giuseppe Simone, Anoop Meraney, Francesco Soria
Rok vydání: 2020
Předmět:
Zdroj: European Urology Focus. 6:1233-1239
ISSN: 2405-4569
DOI: 10.1016/j.euf.2018.11.002
Popis: Background The comparative effectiveness of robotic-assisted radical cystectomy (RARC) versus open radical cystectomy (ORC) in terms of perioperative outcomes is still a matter of debate affecting payors, physicians, and patients. Objective To evaluate comparative perioperative and longer-term morbidity of RARC versus ORC in a multicenter contemporary retrospective cohort of patients. Design, setting, and participants This retrospective multicenter study included patients with bladder cancer treated with radical cystectomy at 10 academic centers between 2000 and 2017. Outcome measurements and statistical analysis Intraoperative outcomes including blood loss and operative time as well as postoperative outcomes including time to discharge, complication, readmission, reoperation, and mortality rates at 30 and 90 d were assessed. Multiple imputation and inverse probability of treatment weighting (IPTW) were used. IPTW-multivariable-adjusted regression and logistic analyses were performed to evaluate the associations of RARC versus ORC with perioperative outcomes at 30 and 90 d. Results and limitations Overall, 1887 patients (1197 RARC and 690 ORC) were included in the study. After IPTW-adjusted analysis, no differences between the groups in terms of preoperative characteristics were observed. RARC was associated with lower blood loss (p Conclusions While RARC was associated with less blood loss and shorter hospital stay, it also led to longer operation times and more readmissions. There were no differences in 30- and 90-d complications. Because there are no apparent differences in safety between ORC and RARC in expert centers, differences in oncologic and cost-effectiveness outcomes are likely to drive decision making regarding RARC utilization. Patient summary In this study we investigated the differences between RARC and ORC in terms of perioperative outcomes. We found no difference in early and late complications. We concluded that, to date, differences in oncologic and cost-effectiveness outcomes should drive decision making regarding RARC utilization.
Databáze: OpenAIRE
Externí odkaz: