“Differences in Postoperative Healthcare Utilization After Robotic and Open Radical Cystectomy: A NSQIP Analysis”

The debate rages on in urologic oncology regarding utilization of open radical cystectomy (ORC) versus robotic assisted radical cystectomy (RARC) for management of bladder cancer. Proponents of each have long highlighted the touted benefits of each approach, but the landscape of high-volume cystectomy surgeons is shifting to surgeons who have trained and practiced in the era where both approaches are heavily utilized. This parallels the experience of many urologists in the prior three decades as there has been an irreversible shift from open prostatectomy to robotic prostatectomy. 1 Multiple randomized trials comparing ORC to RARC have demonstrated equivalent oncologic outcomes, longer OR times and higher direct procedural costs for RARC, but quality of life and post-operative complications rates favoring a robotic over open approach. 2-4 For example, a large prospective randomized trial by Catto and colleagues demonstrated lower rates of thromboembolic (1.9% versus 8.3%) and wound (5.6% versus 16%) complications in RARC compared to ORC, and also observed better patient reported quality of life outcomes and measures of disability in the RARC versus ORC group. 2