TY  - JOUR
TI  - Comparative outcomes of open, laparoscopic, and robot-assisted radical cystectomy using IPTW-adjusted trifecta and pentafecta metrics
AU  - Nishimura, Nobutaka
AU  - Miyake, Makito
AU  - Oda, Yuki
AU  - Shimizu, Takuto
AU  - Iida, Kota
AU  - Tomizawa, Mitsuru
AU  - Onishi, Kenta
AU  - Hori, Shunta
AU  - Morizawa, Yosuke
AU  - Gotoh, Daisuke
AU  - Nakai, Yasushi
AU  - Tanaka, Nobumichi
PY  - 2026
JO  - Exploration of Targeted Anti-tumor Therapy
VL  - 7
SP  - 1002389
DO  - 10.37349/etat.2026.1002389
UR  - https://www.explorationpub.com/Journals/etat/Article/1002389
AB  - Aim: Minimally invasive approaches for radical cystectomy (RC) have been increasingly adopted; however, comparative evidence regarding surgical quality and perioperative outcomes among open (ORC), laparoscopic (LRC), and robot-assisted RC (RARC) remains limited. This study evaluated these three modalities using standardized composite metrics, trifecta and pentafecta, and inverse probability of treatment weighting. Methods: We retrospectively analyzed 192 patients who underwent RC with ileal conduit or neobladder reconstruction between 2006 and 2023. Inverse probability of treatment weighting was applied using comprehensive clinicopathological covariates. Trifecta and pentafecta achievements, perioperative parameters, and postoperative complications were compared among the ORC (n = 110), LRC (n = 38), and RARC (n = 44) groups. Results: RARC achieved the most favorable perioperative and surgical outcomes. Specifically, RARC showed significantly higher rates of several trifecta and pentafecta components than ORC, including fewer positive soft tissue surgical margins (0.0% vs. 5.2%, P < 0.01), reduced major complication rates within 90 days (16.1% vs. 44%, P < 0.05), and fewer urinary diversion–related sequelae within 12 months (1.5% vs. 13.5%, P < 0.05). RARC was also associated with significantly lower blood loss than ORC (380 ± 513 mL vs. 2,913 ± 2,997 mL, P < 0.01), as well as lower rates of pelvic abscess, gastrointestinal anastomotic leakage, and obstructive ileus (all P < 0.01) than ORC. In contrast, LRC was not superior to ORC in terms of major complications or diversion-related outcomes. Local pelvic recurrence within 12 months did not differ significantly among the three modalities. Conclusions: RARC may be a favorable surgical option for reducing perioperative morbidity in patients with high-grade bladder cancer, with comparable 12-month local recurrence rates among surgical approaches.
ER  -