Robotic assisted radical cystectomy: insights on long term oncological outcomes from the International Robotic Cystectomy Consortium

摘要

The goal of minimally invasive surgery in the field of bladder cancer (BCa) is to overcome the complexity of the open approach, to minimize surgical morbidity and to improve recovery. Apart from a brief phase attempting a pure laparoscopic approach, the steep and exhaustive learning curve (LC) and the difficulty of radical cystectomy (RC) made the trend rapingly moving toward the robotic assistance ( ). The introduction of robotic assisted radical cystectomy (RARC) was initially slow, but afterwards it steadily increased both in USA and in Europe ( ). In 12 tertiary referral centers—whose experience has been collected in a multicenter collaboration study from Zamboni —the frequency of RARC has overcome the one of open RC in the 2015–2018 period (54% 46%, respectively) ( ). Notwithstanding some differences—such as major use of neobladder in European countries—the global tendency is similar, with blood loss and length of hospital stay favoring the robotic approach ( , ). Apart from short-term benefits of RARC, some previous oncological concerns—as spread and dissemination of neoplastic cells, atypical sites of recurrence—have been limiting some surgeons technically willing to afford the shift toward robotics for RC. The article from Hussein finally addresses the issue of RARC safety, providing the largest series ever published on oncological outcomes evaluated 10 years after surgery ( ).