Robot-Assisted Versus Conventional Laparoscopic Radical Cystectomy in a Multicenter Cohort Study: A Propensity Score Matching Analysis.

BACKGROUND

Robot-assisted radical cystectomy (RARC) and laparoscopic radical cystectomy (LRC) are becoming increasingly prevalent. However, whether the two surgical procedures share the same oncologic outcomes remains controversial.

PATIENTS AND METHODS

A multicenter, retrospective study was conducted. Patients who underwent radical cystectomy for histologically confirmed bladder cancer at ten centers between 2012 and 2019 were enrolled. Data on baseline conditions, perioperative details, pathological results, and survival outcomes were collected. The primary outcome measures were overall survival (OS), recurrence-free survival (RFS), and cancer-specific survival (CSS). Propensity score matching was conducted to reduce the effects of bias and confounding variables, while multiple imputation was applied to address missing variables.

RESULTS

A total of 2766 patients were enrolled, including 1291 LRC patients and 1475 RARC patients. After propensity score matching, a total of 753 pairs of patients were obtained. In the RARC group, organ-confined diseases were detected in 482 patients (64.0%). Lymph node metastasis was observed in 120 (15.9%) patients. In the LRC group, organ-confined diseases were detected in 521 (69.2%) patients, and 101 (13.4%) patients had lymph node metastasis. The median follow-up time was 47.6 months (33.4-63.4 months) for the RARC group and 45.6 months (23.1-70.8 months) for the LRC group. Survival analysis showed no statistically significant differences in OS (HR: 0.89, 95% CI: 0.72-1.10, p = 0.269), RFS (HR: 0.84, 95% CI: 0.69-1.01, p = 0.069), and CSS (HR: 0.86, 95% CI: 0.68-1.08, p = 0.196) between the two groups. Recurrent bladder cancer, T stage, and lymph node metastasis were identified as significant risk factors.

CONCLUSIONS

There were no statistically significant differences in oncologic outcomes between RARC and LRC.