Introduction: Studies suggest advantages for robot-assisted radical cystectomy (RARC) over open radical cystectomy (ORC), including fewer complications and shorter length of stay (LOS). However, comparisons are often made with historic data, prior to ‘enhanced recovery after surgery’ (ERAS). When evaluating new technology, concommitant changes in peri-operative care act as confounding factors. This study retrospectively reviews 71 ORCs with ERAS, comparing them to published RARC outcomes.

Methods: Consecutive radical cystectomies with ERAS were studied from a single UK centre. The ERAS protocol included pre-operative (comorbidity optimisation, carbohydrate loading, no bowel preparation), intra-operative (infra-umbilical incision, drain avoidance, individualised goal directed fluid therapy, regional anaesthesia and no NG tube) and post-operative (early feeding, mobilisation and absolute avoidance of systemic opiate medication) directives. LOS, pathology, surgical margins and complications were compared to RARC series.

Results: 71 patients underwent ORC from Jan 2013-July 16, mean age 70. 11 patients had additional procedures – 6 urethrectomies, 2 nephro-ureterectomies and 3 large bowel resections. Post cystectomy tumour pathology was: 41% T3/4; 11% T2; 20% Ta/1; 28% T0 - comparable to Yuh’s (2015) meta-analysis data. Lymph node positivity and positive margins were 17% and 13% respectively. Median LOS was 8 days (range 5-43), identical to the International Robotic Cystectomy Consortium (IRCC) median3. Clavien-Dando grade 3-5 complications occurred in 10% within 90 days, compared to 19% from IRCC database.

Conclusions: Our ORC outcomes are similar to those reported for RARC. It is likely perceived gains from RARC are exaggerated and marginal if compared to ORC performed within a modern ERAS program.