Open and Robotic Radical Cystectomy for Muscle-Invasive Bladder Cancer: Techniques, Outcomes, and Evidence.
This review examines the contemporary debate between open radical cystectomy and robotic-assisted radical cystectomy (RARC) for muscle-invasive bladder cancer. Drawing on randomized trials, including RAZOR, iROC, and MSKCC studies, we compare perioperative, oncologic, diversion-related, cost, and patient-reported outcomes. Current high-level evidence demonstrates oncologic noninferiority of RARC, with reduced blood loss but longer operative times and higher costs. Outcomes are strongly influenced by surgeon experience and institutional volume rather than approach alone. We highlight considerations in intracorporeal diversion, learning curves, access disparities, and patient-centered decision-making, emphasizing individualized, value-based surgical selection.