الفهرس 
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Abstract
This study analyzes the prospectively maintained retrospective data of 99 patients to compare the impact of open retrograde extra peritoneal radical cystoprostatectomy (REORC) versus robotic assisted radical cystoprostatectomy with intracorporeal urinary diversion (iRARC) on early surgical outcomes in male patients with bladder cancer.
Data was obtained from the database of two tertiary high volume centers, the center in Egypt (Alexandria Main University Hospital) is highly experienced with transperitoneal ORC but adopted and mastered the technique of the REORC approach since July 2016. The center in the United Kingdom (Guy’s hospital – King’s College – London) has nearly 15 years’ experience in robot-assisted cystoprostatectomy and started adopting intracorporeal diversion as the standard of care in October 2016.
Surgeons from both centers were well beyond the learning curve for the respective procedures, with each of them performing ≥50 cases annually approximately.
Included patients were Males 18 years with pre-cystectomy clinical T1 – T3 disease. Those who had prior major pelvic and/or intraabdominal surgeries, previous pelvic and/or abdominal irradiation, females and those with clinical T4 disease were excluded. All patients were managed according to a standardized Enhanced Recovery After Surgery (ERAS) protocol and all underwent ileal conduit urinary diversion.
50 (50.5%) had undergone REORC and 49 (49.5%) had undergone iRARC. The mean age for the REORC and iRARC groups was 63.62 ± 9.35 and 68.14 ± 8.32 years, respectively. No clinically significant differences were observed regarding the demographic and preoperative characteristics of both groups.
The mean operative time was significantly lower for the REORC group (251.10 ± 37.11) than that for the iRARC group (335.92 ± 56.98) (p < .001). REORC showed significantly higher mean estimated blood loss (986.00 ± 353.70 Vs 382.65 ± 200.66; p < .001) and higher percentage of patients requiring blood transfusion (98% vs. 12.24%). The rate of prolonged postoperative ileus was 16% and 18.4% in REORC and iRARC groups respectively (p= 0.3). No significant differences were found regarding length of hospital stay (p= 0.412), time to flatus, time to tolerate solid oral intake, time to bowel opening (p= 0.423, 0.770 and 0.700 respectively), as well as post-cystectomy pathological outcomes, overall and major complications rates at 30 and 90 days.
In this nonrandomized study, REORC was found to have the equivalent advantages with iRARC regarding early recovery; especially for bowel function, and short LOS. The differences in the outcomes were principally with respect to the blood loss. Thus, in institutions in which surgical robots are not readily available, REORC could constitute a much more cost-effective approach that is less morbid than conventional open radical cystoprostatectomy, with advantages and outcomes comparable to those of iRARC.