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Introduction: While the traditional, gold standard for the management of muscle-invasive bladder cancer has been an open surgical approach, the use of a minimally-invasive robotic radical cystectomy (RC) using the DaVinci® Surgical System has begun to receive wide support. However, there are limited published data comparing robotic surgery with its open counterpart in this disease setting. In the present study, we assessed morbidity of open versus robotic radical cystectomy for bladder cancer.
Materials and Methods: We retrospectively identified 266 patients who received either open or robotic radical cystectomy for management of their bladder cancer at our institution between January 2003-December 2013. Of these, 232 (open: 104; robotic: 128) had complete data. Patient demographics, Charlson Comorbidity Index (CCI) scores, perioperative outcomes, and post-operative complications up to 90 days post-surgery were captured. The association between selected risk factors, comorbidities, CCI score, and patient outcomes for each surgical type were evaluated. The incidence of complications between open and robotic surgery were analyzed using MedCalc Version 12.7.7.0.
Results: The mean age, Charlson Comorbidity Index (CCI) score, and median length of stay for open and robotic surgery candidates were 68.1±10.2 and 66.4±10.4 years; 4.1±3.6 and 4.0±1.7; and 9.00±70.7 and 8.00±74.6 days, respectively. These values were not found to be statistically different between the two groups. Complication rates were assessed up until 90 days post-surgery and were not statistically different (p=0.698) between each surgical approach. A qualitatively similar pattern was observed in relation to rates of both minor (Clavien 1-2; p=0.704) and major (Clavien 3-5; p=0.879) complications.
Conclusions: Our data suggests a similar incidence of peri/postoperative complications in patients undergoing open and robotic radical cystectomy. A limitation of our study does include, however, the possible selection bias in patients eligible for robotic radical cystectomy versus the open approach.

Open versus robotic radical cystectomy: Patient Outcomes

		Open	Robotic	P-Value
No. of Patients		104	128
Mean Age (Range)		68.1±10.2 (38-84)	66.4±10.4 (38-86)	0.247
Mean CCI (Range)		4.1±3.6 (0-10)	4.0±1.7 (0-9)	0.68
Median LOS (Range)		9.00±70.7 (4-56)	8.00±74.6 (5-52)	0.802
No. of Complications		197	194	0.698
	Minor Complications (Clavien 1-2) (n; % of all complications)	149 (75.6)	135 (69.6)	0.704
	Major Complications (Clavien 3-5) (n; % of all complications)	48 (23.4)	59 (30.4)	0.879