Since the implementation of ERAS at USC they have observed significantly decreased length of stay which more recently may be as soon as 3 days patients returning home. The current level one evidence does not does suggest the superiority of robotics over open radical cystectomy. Moreover, he reviewed the USC series among high-volume experts comparing robotic (n=143) versus open radical cystectomy (n=345) from 2013-2017 in patients who also received ERAS.
Preoperative characteristics were comparable between groups. He observed significantly increased median operative times (7.3 hrs vs. 5.4 hrs, p<0.001) with decreased median blood loss (500cc vs. 200 cc, p<0.001), for the robotic vs. open groups, respectively. However, the median length of stay was significantly longer for the robotic vs. open group (6 vs. 4 days, p<0.001), respectively. There was no difference in complications or readmission rates.
In conclusion, in the framework of an ERAS protocol, the surgical approach is not a determinant of complications or readmission rates following radical cystectomy. ERAS protocols reduce the length of stay without an increase in readmission or complication rates regardless of surgical approach. In an era where we need to embrace and apply the evidence, the current data suggest radical cystectomy should be performed by high-volume surgeons and centers with dedicated infrastructure to optimize surgical outcomes regardless of approach. However, at present, there remains little to support robotics superiority over open radical cystectomy which does not take into accounts costs associated with either technique.
Presented by: Siamak Daneshmand, MD, Associate Professor of Urology Keck School of Medicine USC with Clinical Scholar designation, Director of clinical research and the urologic oncology fellowship program
Written by: Stephen B. Williams, MD, Associate Professor, Division of Urology, The University of Texas Medical Branch, Galveston, Texas at the 7th ERAS World Congress, Liverpool, UK, 1-3 May 2019.