Comparative efficacy and safety of open, laparoscopic, and robot-assisted radical cystectomy: a systematic review and network meta-analysis

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: Not specified in abstract

• Primary Outcome: Minimally invasive techniques showed reduced blood loss and transfusion rates compared to open surgery

• Nnt Or Sensitivity: Laparoscopic surgery potentially superior for postoperative recovery, but results require cautious interpretation

• Confidence Interval: Not reported in abstract

Clinical Application

Limited by surgeon expertise, institutional resources, and patient selection criteria for minimally invasive surgery Relevant to Australian urological practice, though cost-effectiveness considerations for robotic surgery under PBS funding would be important Patients with bladder cancer requiring radical cystectomy who are suitable for minimally invasive approaches

Abstract

The most appropriate surgical strategy for radical cystectomy in bladder cancer remains to be established. This study performed a network meta-analysis of randomized controlled trials to evaluate open, laparoscopic, and robot-assisted approaches. Outcomes were systematically classified into intraoperative metrics, postoperative recovery, perioperative safety, and oncological efficacy. A random effects model was employed, and treatment hierarchy was determined using the surface under the cumulative ranking curve. Eleven studies comprising 1270 patients met the inclusion criteria. Compared with open surgery, minimally invasive techniques were associated with reduced intraoperative blood loss and lower transfusion rates, although they required longer operative time. Among these, laparoscopic surgery was associated with a potentially greater likelihood of enhanced postoperative recovery and fewer complications, although these findings should be interpreted with caution given the sparse network and substantial heterogeneity in some outcomes. Robot-assisted procedures did not demonstrate consistent superiority over laparoscopy in perioperative measures. Oncological outcomes were similar across all modalities. Overall, minimally invasive approaches confer perioperative benefits and appear comparable to open surgery with respect to short-term surrogate oncological endpoints, although long-term outcomes remain to be determined.

References

1. 1.Zhao, L., Chen, H. M., Li, Y. T., Zhang, T., Yang, J. W., Wang, L., Li, X. R., Shao, L. C., & Chen, S. Y. (2026). Comparative efficacy and safety of open, laparoscopic, and robot-assisted radical cystectomy: a systematic review and network meta-analysis. Journal of Robotic Surgery. https://doi.org/10.56434/j.arch.esp.urol.20237603.23