Open versus Robot-Assisted Radical Cystectomy for the Treatment of pT4a Bladder Cancer: Comparison of Perioperative Outcomes

Simple Summary Bladder cancer is the second most common genitourinary malignancy. Robotic-assisted radical cystectomy has demonstrated comparable efficacy in treating bladder cancer to open radical cystectomy. Due to the features of the procedure itself and the often weak general health status of patients, radical cystectomy is related to a significant incidence of complications. During the last decades, robotic surgery has spread in bladder cancer treatment in order to take advantage of the benefits of minimally invasive surgery. However, the majority of evidence in the literature comes from cT2-T3 muscle-invasive bladder cancer. The management of patients with cT4 stage represents a relevant surgical challenge. The aim of the present study is to compare intra- and postoperative outcomes of robot-assisted and open radical cystectomy in the treatment of patients with a pT4a MIBC in a pathological report.Abstract We compared the perioperative outcomes of open (ORC) vs. robot-assisted (RARC) radical cystectomy in the treatment of pT4a MIBC. In total, 212 patients underwent ORC (102 patients, Group A) vs. RARC (110 patients, Group B) for pT4a bladder cancer. Patients were prospectively followed and retrospectively reviewed. We assessed operative time, estimated blood loss (EBL), intraoperative and postoperative complications, length of stay, transfusion rate, and oncological outcomes. Preoperative features were comparable. The mean operative time was 232.8 vs. 189.2 min (p = 0.04), and mean EBL was 832.8 vs. 523.7 mL in Group A vs. B (p = 0.04). An intraoperative transfusion was performed in 32 (31.4%) vs. 11 (10.0%) cases during ORC vs. RARC (p = 0.03). The intraoperative complications rate was comparable. The mean length of stay was shorter after RARC (12.6 vs. 7.2 days, p = 0.02). Postoperative transfusions were performed in 36 (35.3%) vs. 13 (11.8%) cases (p = 0.03), and postoperative complications occurred in 37 (36.3%) vs. 29 (26.4%) patients in Groups A vs. B (p = 0.05). The positive surgical margin (PSM) rate was lower after RARC. No differences were recorded according to the oncological outcomes. ORC and RARC are feasible treatments for the management of pT4a bladder tumors. Minimally invasive surgery provides shorter operative time, bleeding, transfusion rate, postoperative complications, length of stay, and PSM rate.