Minimally invasive cystectomy reduces blood loss and transfusions but extends operative time

The most appropriate surgical strategy for radical cystectomy in bladder cancer remains to be established. This study performed a network meta-analysis of randomized controlled trials to evaluate open, laparoscopic, and robot-assisted approaches. Outcomes were systematically classified into intraoperative metrics, postoperative recovery, perioperative safety, and oncological efficacy. A random effects model was employed, and treatment hierarchy was determined using the surface under the cumulative ranking curve. Eleven studies comprising 1270 patients met the inclusion criteria. Compared with open surgery, minimally invasive techniques were associated with reduced intraoperative blood loss and lower transfusion rates, although they required longer operative time. Among these, laparoscopic surgery was associated with a potentially greater likelihood of enhanced postoperative recovery and fewer complications, although these findings should be interpreted with caution given the sparse network and substantial heterogeneity in some outcomes. Robot-assisted procedures did not demonstrate consistent superiority over laparoscopy in perioperative measures. Oncological outcomes were similar across all modalities. Overall, minimally invasive approaches confer perioperative benefits and appear comparable to open surgery with respect to short-term surrogate oncological endpoints, although long-term outcomes remain to be determined.