“A comprehensive analysis of robot-assisted versus open radical cystectomy: Insights on Quality-of-Life outcomes and socio-economic implications at a high volume tertiary referral Center”.

Open radical cystectomy (ORC) with bilateral pelvic lymph node dissection is the standard of care for muscle-invasive bladder cancer. However, despite surgical improvements, radical cystectomy is associated with a high rate of perioperative complications and a non-negligible mortality rate. In the last decade, the spread of minimally invasive surgery in urologic procedures has dramatically increased and, in this scenario, robot-assisted radical cystectomy (RARC) has been proposed with the aim to optimize the effectiveness of surgical procedures and reduce the complication burden of open surgery. Nonetheless, the increased operative times, the lack of long-term oncologic and functional analysis still burdens on the use of RARC. Moreover, limited and sparse evidences have reported significantly increased procedural and material costs of RARC compared with open approach; as such, the cost -effectiveness of RARC against ORC is still matter of debate. However, recent investigations highlighted the potential “hidden” benefits of robotics over open surgery, beyond just the perioperative outcomes, in terms of shorter sick leave and quicker return to work, as well as potential advantages in terms of increased Quality of Life (QoL) after surgery. Furthermore, the perioperative outcomes of radical cystectomy strongly depend on the type of urinary diversion (namely, cutaneous stoma, ileal conduit or orthotopic neobladder) and, in this context, the impact of the surgical approach (open versus robotic) on each type of diversion is still unknown. Aim of this study is to assess and compare the perioperative outcomes of open and robot-assisted radical cystectomy with a particular focus on QoL outcomes and sick leave and return to work.