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Page 6 of 12                                                                                  Miller et al. Mini-invasive Surg 2021;5:24  https://dx.doi.org/10.20517/2574-1225.2021.25



                                                                        RARC                 94          6 (8)        14.9 (SD 10.0)                                              79%, 2 yr  84%, 2 yr  84%, 2 yr
                                            [22]
                              Matulewicz et al.              2016       ORC                  9639        (13)         11 (IQR 5-19)*                                              nr         nr         nr
                                                                        RARC                 2397        (11)         16 (IQR 9-25)                                               nr         nr         nr
                                        [23]                                                                                                                                              #
                              Nguyen et al.                  2015       ORC                  120         15 (13)*     20 (IQR 11-27)                                              60%, 5 yr  nr         nr
                                                                                                                                                                                          #
                                                                        RARC                 263         16 (6)       21 (IQR 13-28)                                              70%, 5 yr  nr         nr
                                         [24]
                              Atmaca et al.                  2015       ORC                  42          1 (2)        17 (SD 13.5)                                                nr         nr         nr
                                                                        RARC, ICUD only      32          2 (6)        25 (SD 9.7)                                                 nr         nr         nr
                              Non-comparative studies
                                              [25]
                              IRCC, Elsayed et al.           2021       RARC only            2107        nr           nr                                                          66%, 5 yr  nr         60%, 5 yr
                                         [26]
                              Brassetti et al.               2020       RARC, ICUD only      113         9 (8)        36 (IQR 28-45)                                              58%, 5 yr  61%, 5 yr  54%, 5 yr
                                              [27]
                              IRCC, Hussein et al.           2019       RARC only            446         30 (7)       14 (IQR 9-22)                                               59%, 10 yr  65%, 10 yr 35%, 10 yr
                                             [29]
                              ERUS, Collins et al.           2017       RARC, ICUD only      717         34 (4)       18 (IQR 13-25)                                              75%, 2 yr
                                           [30]
                              IRCC, Raza et al.              2015       RARC only            702         55 (8)       16 (IQR 10-24)                                              67%, 5 yr  75%, 5 yr  50%, 5 yr
                                                [31]
                              IRCC, Hellenthal, et al.       2011       RARC only            527         nr           17.8 (range 0-68)                                           nr         nr         nr
                                                [32]
                              IRCC, Hellenthal, et al.       2010       RARC only            513         35 (6.8)     nr                                                          nr         nr         nr

                             #                                                                                                     *
                              Visual estimate based on Kaplan Meier curves provided in paper (specific numbers not provided by reference in text).  P < 0.05. PSM: Positive surgical margin; SD: standard deviation; IQR: interquartile range; RFS:
                             recurrence free survival; CSS: cancer-specific survival; OS: overall survival; ORC: open radical cystectomy; RARC: robotic assisted radical cystectomy; LRC: laparoscopic radical cystectomy; nr: not reported; ICUD:
                             intracorporeal urinary diversion; RAZOR: randomized open vs. robotic cystectomy; CORAL: controlled three-arm trial of open, robotic, and laparoscopic radical cystectomy; RACE: radical cystectomy evaluation;
                             IRCC: International Robotic Cystectomy Consortium; ERUS: European Association of Urology Robotic Urology Section.


                             or variant lymphatic dissemination related to robotic technique .
                                                                                                      [23]


                             Nguyen et al.  reported atypical patterns of recurrence in a non-randomized single center comparative study of ORC vs. RARC, including higher incidence of
                                            [23]
                             peritoneal carcinomatosis (21% vs. 8%) and extra pelvic lymph node (23% vs. 15%) [Table 3]. However, the denominator of these estimated proportions was
                             distant recurrences and not overall recurrence, as is typically reported. It was additionally notable that distant recurrences were not significantly different
                             between the two approaches, and the authors noted that selection bias may have contributed to these findings. The same group published a follow up study
                             consisting of 310 patients and found that predictors of distant recurrences, peritoneal carcinomatosis and extra pelvic lymph node metastases did not

                                                                                                                                                                                [46]
                                                                                                                                                                                                    [9]
                             significantly differ and concluded that tumor biology is likely the chief influencer of atypical recurrence, not surgical approach . Bochner et al.  later found
                             that there was variation in location of recurrence and that RARC resulted in greater numbers of recurrences in the abdomen and pelvis. However, this only
                             achieved significance when pooled and stratification of abdominal recurrences as separate from distant and local recurrences is controversial and of unclear
                                                   [47]
                             clinical significance . Notably, the study was not powered to determine differences in patterns of recurrence.
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