Outcomes of Robot-Assisted Radical Cystectomy

Robot-assisted radical cystectomy (RARC) has been proposed as an alternative to open RC (ORC) to improve perioperative outcomes, without compromising oncological results. Several randomized controlled trials (RCTs) have shown the non-inferiority of the robotic approach compared to the open approach. An update of the RAZOR trial was recently published, showing a similar progression-free survival rate at 36 months between the RARC arm (68.4%) and the ORC arm (65.4%, p = 0.60). It has been speculated that RARC may be associated with a risk of cell seeding due to pneumoperitoneum, however, there is no strong evidence that RARC would be associated with a higher rate of pelvic or unusual recurrence (i.e., peritoneal carcinomatosis and port-site metastases). Most of published studies showed that RARC promoted higher ureteroenteric anastomosis stricture incidence rates compared to ORC. The risk of stricture depending on the type of urinary diversion used (intracorporeal vs. extracorporeal) remains unclear. Data on sexual-sparing RARC are immature, but there is a promise of better sexual outcomes than standard RC without compromising oncologic outcomes. Patients suitable for this technique must be carefully selected. There is high-quality evidence to suggest that the health-related quality of life outcomes after ORC and RARC are similar.