Robot-assisted radical cystectomy with intracorporeal urinary diversion – The new ‘gold standard’? Evidence from a systematic review

Objective: To investigate whether a totally intracorporeally radical cystectomy (RC) can be considered the new ‘gold standard’ in bladder cancer, as open RC (ORC) is the current ‘gold standard’ for surgical treatment of muscle-invasive and high-grade non-muscle-invasive bladder cancer. However, robo...

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Autores principales:	Niyati Lobo, Ramesh Thurairaja, Rajesh Nair, Prokar Dasgupta, Muhammad Shamim Khan
Formato:	article
Lenguaje:	EN
Publicado:	Taylor & Francis Group 2018
Materias:	Diseases of the genitourinary system. Urology RC870-923
Acceso en línea:	https://doaj.org/article/a5463329b2844c868c5855530763fedf
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spelling	oai:doaj.org-article:a5463329b2844c868c5855530763fedf2021-12-02T08:22:58ZRobot-assisted radical cystectomy with intracorporeal urinary diversion – The new ‘gold standard’? Evidence from a systematic review2090-598X10.1016/j.aju.2018.01.006https://doaj.org/article/a5463329b2844c868c5855530763fedf2018-09-01T00:00:00Zhttp://www.sciencedirect.com/science/article/pii/S2090598X18300305https://doaj.org/toc/2090-598XObjective: To investigate whether a totally intracorporeally radical cystectomy (RC) can be considered the new ‘gold standard’ in bladder cancer, as open RC (ORC) is the current ‘gold standard’ for surgical treatment of muscle-invasive and high-grade non-muscle-invasive bladder cancer. However, robot-assisted radical cystectomy (RARC) is becoming the preferred surgical approach in many centres as it seems to maintain the oncological control of open surgery whilst offering improved perioperative benefits. Materials and methods: A review of the literature was conducted using the Pubmed/MEDLINE, ISI Web of Knowledge and Cochrane Databases to identify studies that included both ORC and RARC with intracorporeal and extracorporeal urinary diversion (UD) published up to July 2017. Results: Evidence from four single-centre randomised controlled trials and now the multicentre Randomized Trial of Open versus Robotic Cystectomy (RAZOR) trial demonstrate the oncological equivalence of RARC to ORC. The only convincing evidence for the superiority of RARC is in the area of blood loss and transfusion rates. However, the UD procedure in these trials was performed extracorporeally and, to realise the full benefits of RARC, a totally intracorporeal approach is needed. Intracorporeal UDs (ICUDs) have been shown to be technically feasible by a few expert centres and have demonstrated some improved short-term perioperative outcomes compared to extracorporeal UDs. Conclusions: Although initial outcomes appear promising, RARC with ICUD is far from gaining ‘gold standard’ status. Further studies are needed to confirm that outcomes are reproducible widely. Furthermore, the benefits of a totally intracorporeal approach must be confirmed in randomised controlled trials. Keywords: Radical cystectomy, Intracorporeal urinary diversion, Extracorporeal urinary diversion, Robotics, Bladder cancerNiyati LoboRamesh ThurairajaRajesh NairProkar DasguptaMuhammad Shamim KhanTaylor & Francis GrouparticleDiseases of the genitourinary system. UrologyRC870-923ENArab Journal of Urology, Vol 16, Iss 3, Pp 307-313 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	Diseases of the genitourinary system. Urology RC870-923
spellingShingle	Diseases of the genitourinary system. Urology RC870-923 Niyati Lobo Ramesh Thurairaja Rajesh Nair Prokar Dasgupta Muhammad Shamim Khan Robot-assisted radical cystectomy with intracorporeal urinary diversion – The new ‘gold standard’? Evidence from a systematic review
description	Objective: To investigate whether a totally intracorporeally radical cystectomy (RC) can be considered the new ‘gold standard’ in bladder cancer, as open RC (ORC) is the current ‘gold standard’ for surgical treatment of muscle-invasive and high-grade non-muscle-invasive bladder cancer. However, robot-assisted radical cystectomy (RARC) is becoming the preferred surgical approach in many centres as it seems to maintain the oncological control of open surgery whilst offering improved perioperative benefits. Materials and methods: A review of the literature was conducted using the Pubmed/MEDLINE, ISI Web of Knowledge and Cochrane Databases to identify studies that included both ORC and RARC with intracorporeal and extracorporeal urinary diversion (UD) published up to July 2017. Results: Evidence from four single-centre randomised controlled trials and now the multicentre Randomized Trial of Open versus Robotic Cystectomy (RAZOR) trial demonstrate the oncological equivalence of RARC to ORC. The only convincing evidence for the superiority of RARC is in the area of blood loss and transfusion rates. However, the UD procedure in these trials was performed extracorporeally and, to realise the full benefits of RARC, a totally intracorporeal approach is needed. Intracorporeal UDs (ICUDs) have been shown to be technically feasible by a few expert centres and have demonstrated some improved short-term perioperative outcomes compared to extracorporeal UDs. Conclusions: Although initial outcomes appear promising, RARC with ICUD is far from gaining ‘gold standard’ status. Further studies are needed to confirm that outcomes are reproducible widely. Furthermore, the benefits of a totally intracorporeal approach must be confirmed in randomised controlled trials. Keywords: Radical cystectomy, Intracorporeal urinary diversion, Extracorporeal urinary diversion, Robotics, Bladder cancer
format	article
author	Niyati Lobo Ramesh Thurairaja Rajesh Nair Prokar Dasgupta Muhammad Shamim Khan
author_facet	Niyati Lobo Ramesh Thurairaja Rajesh Nair Prokar Dasgupta Muhammad Shamim Khan
author_sort	Niyati Lobo
title	Robot-assisted radical cystectomy with intracorporeal urinary diversion – The new ‘gold standard’? Evidence from a systematic review
title_short	Robot-assisted radical cystectomy with intracorporeal urinary diversion – The new ‘gold standard’? Evidence from a systematic review
title_full	Robot-assisted radical cystectomy with intracorporeal urinary diversion – The new ‘gold standard’? Evidence from a systematic review
title_fullStr	Robot-assisted radical cystectomy with intracorporeal urinary diversion – The new ‘gold standard’? Evidence from a systematic review
title_full_unstemmed	Robot-assisted radical cystectomy with intracorporeal urinary diversion – The new ‘gold standard’? Evidence from a systematic review
title_sort	robot-assisted radical cystectomy with intracorporeal urinary diversion – the new ‘gold standard’? evidence from a systematic review
publisher	Taylor & Francis Group
publishDate	2018
url	https://doaj.org/article/a5463329b2844c868c5855530763fedf
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Robot-assisted radical cystectomy with intracorporeal urinary diversion – The new ‘gold standard’? Evidence from a systematic review

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