Perioperative and Oncological Outcomes of Robot-assisted Versus Open Radical Cystectomy: A Propensity Score-matched Multicenter Study from Japan

Background/Aim: This study aimed to compare the perioperative and oncological outcomes of open radical cystectomy (ORC) and robot-assisted radical cystectomy (RARC) in a contemporary propensity score-matched multicenter cohort from Japan and to provide additional real-world evidence. Patients and Methods: We retrospectively reviewed 438 patients who underwent radical cystectomy for bladder cancer at four Japanese institutions between March 2009 and December 2024. After excluding patients who underwent laparoscopic radical cystectomy, 397 patients were included. Propensity score matching was performed in a 1:1 ratio based on age, sex, body mass index, Charlson comorbidity index, pathological T stage, pathological nodal status, and type of urinary diversion, resulting in 123 matched pairs. Perioperative outcomes, postoperative complications, and recurrence-free survival (RFS) were compared between the ORC and RARC groups. Results: After propensity score matching, baseline characteristics were generally balanced between the groups. The RARC group had a significantly longer operative time than the ORC group (461 min vs. 374 min, p<0.01). However, the RARC group had significantly lower estimated blood loss (240 ml vs. 1238 ml, p<0.01) and lower intraoperative transfusion rates (14% vs. 90%, p<0.01). The RARC group also had a significantly shorter postoperative hospital stay than the ORC group (23 vs. 28 days, p<0.01). Early and late postoperative complication rates were comparable between the groups. No significant difference in RFS was observed between the groups. Conclusion: In this Japanese cohort, RARC was associated with reduced blood loss, lower transfusion rates, and shorter postoperative hospitalization while maintaining postoperative complication rates and oncological outcomes comparable to those of ORC.