Robot-Assisted Cystectomy in Patients With Previous Pelvic Irradiation: A Comprehensive Systematic Review and Single-Arm Meta-Analysis

To evaluate the perioperative outcomes of robot-assisted cystectomy in previous pelvic irradiation patients. We performed a systematic review with a single-arm meta-analysis, searching the PubMed, Embase, Scopus, and Cochrane databases through July 2024. Included studies reported perioperative outcomes of robot-assisted radical cystectomy in patients with prior pelvic irradiation. Extracted data included operative time, blood loss, complication rates (using the Clavien-Dindo classification), readmission rates, and length of hospital stay. Study quality was assessed and a single-arm meta-analysis was conducted to synthesize the data. This systematic review included 150 patients from 4 retrospective studies. The median operative time ranged from 330 to 382 minutes (Overall Mean = 349.50 min; 95% CI, 331-380), and blood loss varied between 264 mL and 495 mL (Overall Mean = 351.50 mL; 95% CI, 264-495). Major complications, defined as Clavien-Dindo grade ≥ III, were reported in 20% to 32% of cases, while total early complications within 90 days ranged from 53% to 59% (Overall rate = 0.58; 95% CI, 0.42-0.75). The readmission rate within 90 days varied between 22% and 40% (Overall rate = 0.31; 95% CI, 0.16-0.47). RARC in patients with prior pelvic irradiation resulted in comparable perioperative outcomes to nonirradiated patients. This review highlights the potential safety and efficacy of RARC in this complex patient group. Future studies comparing surgical approaches with detailed reporting on radiation exposure are essential to validate these findings.