***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The aim of this study was to compare the morbidity , mortality , oncological results and quality of life between  laparoscopic radical cystectomy ( LRC ) and open radical cystectomy ( ORC ) in the elderly patients over 75 years old . Between January 2012 and January 2015 , 60 patients were recruited into this study , who were r and omly assigned in a 1:1 ratio to either LRC or ORC group . Baseline patient characteristics , pathological factors , operative and postoperative characteristics , postoperative complications and survival data were retrospectively collected , analyzed and compared between the two groups . Patients in LRC group and ORC group had comparable baseline characteristics and pathological factors ( all P > 0.05 ) . LRC group required longer operative time ( 408.2 ± 76.9 vs. 311.7 ± 65.3 min , P = 0.000 ) and had less EBL ( 621.6 ± 100.7 vs. 1088.5 ± 109.4 ml , P = 0.000 ) compared with ORC group . The incidence of infection and ileus within 90 days after surgery in ORC group was significantly higher than LRC group(6.9 % vs. 28.6 % , P = 0.041 ; 3.4 % vs. 25 % , P = 0.025 ) . At a median follow-up of 28 months ( range 12–48 months ) , the survival analysis showed that there were no significant differences between the LRC and ORC groups in overall survival ( log-rank χ2 = 0.122 ; P = 0.726 ) , or progress-free survival ( log-rank χ2 = 0.153 ; P = 0.696 ) . In conclusion , this study confirmed that LRC could achieve similar tumor treatment efficacy compared to ORC , with fewer perioperative complications and less blood loss . We suggest that LRC should be considered as the primary intervention for patients aged over 75 years old with muscle invasive bladder cancer or non-muscle invasive bladder cancer with high risk factors PURPOSE Robotic assisted laparoscopic radical cystectomy for bladder cancer has been reported with potential for improvement in perioperative morbidity compared to the open approach . However , most studies are retrospective with significant selection bias . MATERIAL S AND METHODS A pilot prospect i ve r and omized trial evaluating perioperative outcomes and oncologic efficacy of open vs robotic assisted laparoscopic radical cystectomy for consecutive patients was performed from July 2009 to June 2011 . RESULTS To date 47 patients have been r and omized with data available on 40 patients for analysis . Each group was similar with regard to age , gender , race , body mass index and comorbidities , as well as previous surgeries , operative time , postoperative complications and final pathological stage . We observed no significant differences between oncologic outcomes of positive margins ( 5 % each , p = 0.50 ) or number of lymph nodes removed for open radical cystectomy ( 23 , IQR 15 - 28 ) vs robotic assisted laparoscopic radical cystectomy ( 11 , IQR 8.75 - 21.5 ) groups ( p = 0.135 ) . The robotic assisted laparoscopic radical cystectomy group ( 400 ml , IQR 300 - 762.5 ) was noted to have decreased estimated blood loss compared to the open radical cystectomy group ( 800 ml , IQR 400 - 1,100 ) and trended toward a decreased rate of excessive length of stay ( greater than 5 days ) ( 65 % vs 90 % , p = 0.11 ) compared to the open radical cystectomy group . The robotic group also trended toward fewer transfusions ( 40 % vs 50 % , p = 0.26 ) . CONCLUSIONS Our study vali date s the concept of r and omizing patients with bladder cancer undergoing radical cystectomy to an open or robotic approach . Our results suggest no significant differences in surrogates of oncologic efficacy . Robotic assisted laparoscopic radical cystectomy demonstrates potential benefits of decreased estimated blood loss and decreased hospital stay compared to open radical cystectomy . Our results need to be vali date d in a larger multicenter prospect i ve r and omized clinical trial BACKGROUND Open radical cystectomy ( ORC ) and urinary diversion in patients with bladder cancer ( BCa ) are associated with significant perioperative complication risk . OBJECTIVE To compare perioperative complications between robot-assisted radical cystectomy ( RARC ) and ORC techniques . DESIGN , SETTING , AND PARTICIPANTS A prospect i ve r and omized controlled trial was conducted during 2010 and 2013 in BCa patients scheduled for definitive treatment by radical cystectomy ( RC ) , pelvic lymph node dissection ( PLND ) , and urinary diversion . Patients were r and omized to ORC/PLND or RARC/PLND , both with open urinary diversion .  Patients were followed for 90 d postoperatively . INTERVENTION St and ard ORC or RARC with PLND ; all urinary diversions were performed via an open approach . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Primary outcomes were overall 90-d grade 2 - 5 complications defined by a modified Clavien system . Secondary outcomes included comparison of high- grade complications , estimated blood loss , operative time , pathologic outcomes , 3- and 6-mo patient-reported quality -of-life ( QOL ) outcomes , and total operative room and inpatient costs . Differences in binary outcomes were assessed with the chi-square test , with differences in continuous outcomes assessed by analysis of covariance with r and omization group as covariate and , for QOL end points , baseline score . RESULTS AND LIMITATIONS The trial enrolled 124 patients , of whom 118 were r and omized and underwent RC/PLND . Sixty were r and omized to RARC and 58 to ORC . At 90 d , grade 2 - 5 complications were observed in 62 % and 66 % of RARC and ORC patients , respectively ( 95 % confidence interval for difference , -21 % to -13 % ; p=0.7 ) . The similar rates of grade 2 - 5 complications at our m and ated interim analysis met futility criteria ; thus , early closure of the trial occurred . The RARC group had lower mean intraoperative blood loss ( p=0.027 ) but significantly longer operative time than the ORC group ( p<0.001 ) . Pathologic variables including positive surgical margins and lymph node yields were similar . Mean hospital stay was 8 d in both arms ( st and ard deviation , 3 and 5 d , respectively ; p=0.5 ) . Three- and 6-mo QOL outcomes were similar between arms . Cost analysis demonstrated an advantage to ORC compared with RARC . A limitation is the setting at a single high-volume , referral center ; our findings may not be generalizable to all setting s. CONCLUSIONS This trial failed to identify a large advantage for robot-assisted techniques over st and ard open surgery for patients undergoing RC/PLND and urinary diversion . Similar 90-d complication rates , hospital stay , pathologic outcomes , and 3- and 6-mo QOL outcomes were observed regardless of surgical technique . PATIENT SUMMARY Of 118 patients with bladder cancer who underwent radical cystectomy , pelvic lymph node dissection , and urinary diversion , half were r and omized to open surgery and half to robot-assisted laparoscopic surgery .  We compared the rate of complications within 90 d after surgery for the open group versus the robotic group and found no significant difference between the two groups . TRIAL REGISTRATION Clinical Trials.gov identifier NCT01076387 , www . clinical trials.gov BACKGROUND In recent years , surgeons have begun to report case series of minimally invasive approaches to radical cystectomy , including robotic-assisted techniques demonstrating the surgical feasibility of this procedure with the potential of lower blood loss and more rapid return of bowel function and hospital discharge . Despite these experiences and observations , at this point high levels of clinical evidence with regard to the benefits of robotic cystectomy are absent , and the current experiences represent case series with limited comparisons to historical controls at best . OBJECTIVE We report our results on a prospect i ve r and omized trial of open versus robotic-assisted laparoscopic radical cystectomy with regard to perioperative outcomes , complications , and short-term narcotic usage . DESIGN , SETTING , AND PARTICIPANTS A prospect i ve r and omized single-center noninferiority study comparing open versus robotic approaches to cystectomy in patients who are c and i date s for radical cystectomy for urothelial carcinoma of the bladder . Of the 41 patients who underwent surgery , 21 were r and omized to the robotic approach and 20 to the open technique . INTERVENTION Radical cystectomy , bilateral pelvic lymphadenectomy , and urinary diversion by either an open approach or by a robotic-assisted laparoscopic technique . MEASUREMENTS The primary end point was lymph node ( LN ) yield with a noninferiority margin of four LNs . Secondary end points included demographic characteristics , perioperative outcomes , pathologic results , and short-term narcotic use . RESULTS AND LIMITATIONS On univariate analysis , no significant differences were found between the two groups with regard to age , sex , body mass index , American Society of Anesthesiologists classification , anticoagulation regimen of aspirin , clinical stage , or diversion type . Significant differences were noted in operating room time , estimated blood loss , time to flatus , time to bowel movement , and use of inpatient morphine sulfate equivalents . There was no significant difference in regard to overall complication rate or hospital stay . On surgical pathology , in the robotic group 14 patients had pT2 disease or higher ; 3 patients had pT3/T4 disease ; and 4 patients had node-positive disease . In the open group , eight patients had pT2 disease or higher ; five patients had pT3/T4 disease ; and seven patients had node-positive disease . The mean number of LNs removed was 19 in the robotic group versus18 in the open group . Potential study limitations include the limited clinical and oncologic follow-up and the relatively small and single-institution nature of the study . CONCLUSIONS We present the results of a prospect i ve r and omized controlled noninferiority study with a primary end point of LN yield , demonstrating the robotic approach to be noninferior to the open approach . The robotic approach also compares favorably with the open approach in several perioperative parameters BACKGROUND Radical cystectomy is the surgical st and ard for invasive bladder cancer . Robot-assisted cystectomy has been proposed to provide similar oncological outcomes with lower morbidity . We aim ed to compare progression-free survival in patients with bladder cancer treated with open cystectomy and robot-assisted cystectomy .  METHODS The RAZOR study is a r and omised , open-label , non-inferiority , phase 3 trial done in 15 medical centres in the USA . Eligible participants ( aged ≥18 years ) had biopsy-proven clinical stage T1-T4 , N0-N1 , M0 bladder cancer or refractory carcinoma in situ . Individuals who had previously had open abdominal or pelvic surgery , or who had any pre-existing health conditions that would preclude safe initiation or maintenance of pneumoperitoneum were excluded . Patients were central ly assigned ( 1:1 ) via a web-based system , with block r and omisation by institution , stratified by type of urinary diversion , clinical T stage , and Eastern Cooperative Oncology Group performance status , to receive robot-assisted radical cystectomy or open radical cystectomy with extracorporeal urinary diversion . Treatment allocation was only masked from pathologists . The primary endpoint was 2-year progression-free survival , with non-inferiority established if the lower bound of the one-sided 97·5 % CI for the treatment difference ( robotic cystectomy minus open cystectomy ) was greater than -15 percentage points . The primary analysis was done in the per- protocol population . Safety was assessed in the same population . This trial is registered with Clinical Trials.gov , number NCT01157676 . FINDINGS Between July 1 , 2011 , and Nov 18 , 2014 , 350 participants were r and omly assigned to treatment . The intended treatment was robotic cystectomy in 176 patients and open cystectomy in 174 patients . 17 ( 10 % ) of 176 patients in the robotic cystectomy group did not have surgery and nine ( 5 % ) patients had a different surgery to that they were assigned . 21 ( 12 % ) of 174 patients in the open cystectomy group did not have surgery and one ( 1 % ) patient had robotic cystectomy instead of open cystectomy . Thus , 302 patients ( 150 in the robotic cystectomy group and 152 in the open cystectomy group ) were included in the per- protocol analysis set . 2-year progression-free survival was 72·3 % ( 95 % CI 64·3 to 78·8 ) in the robotic cystectomy group and 71·6 % ( 95 % CI 63·6 to 78·2 ) in the open cystectomy group ( difference 0·7 % , 
    Output:
    
No significant differences were found between MIRC and ORC in two oncologic outcomes : the recurrence rate and mortality .
Additionally , no significant differences were found in three pathologic outcomes : lymph node yield , positive lymph nodes , and positive surgical margins .
With respect to perioperative outcomes , however , MIRC showed a significantly longer operating time , less estimated blood loss , lower blood transfusion rate , shorter time to regular diet , and shorter length of hospital stay than ORC .
The incidence of complications was similar between the two techniques .
We found no statistically significant differences in the above outcomes between robot-assisted radical cystectomy and ORC or between laparoscopic radical cystectomy and ORC with the exception of the complication rate .
Conclusions MIRC is an effective and safe surgical approach in the treatment of bladder cancer .