根治性膀胱切除术代表治疗局部肌肉浸润或高级别非肌肉浸润BCG无反应性膀胱癌的标准。已经发表了多项随机对照试验来比较传统开放式（ORC）和机器人辅助根治性膀胱切除术（RARC）。我们旨在通过系统回顾和Meta分析总结在这个领域的证据。根据PRISMA指南进行系统搜索，检索所有已发布的比较ORC和RARC的随机前瞻性试验，并调查总体并发症、高级别（Clavien-Dindo≥3）并发症、手术切缘阳性、移除的淋巴结数量、估计失血量、手术时间、住院时间、生活质量、总生存期和无进展生存期的风险。采用随机效应模型进行分析。还进行了基于尿路分流的亚组分析。共收纳了七项试验，涵盖974名患者。RARC和ORC之间在主要肿瘤学和围手术期结果方面发现没有差异。然而，RARC住院时间显著较短（MD -0.95; 95%CI -1.32，-0.58），估计失血量更少（MD -296.66; 95%CI -462.59，-130.73）。ORC的手术时间总体较短（MD 89.52; 95%CI 55.88，123.16），然而，在体内尿路分流方面，ORC和RARC之间没有差异。尽管包含试验的异质性和可能未解决的混杂因素存在许多限制，但我们得出结论，ORC和RARC同样适用于治疗晚期膀胱癌患者的手术治疗选择。

Radical cystectomy represents the standard of care for localized muscle invasive or high-grade non-muscle invasive BCG unresponsive bladder cancer. Several randomized control trials have been published comparing open (ORC) with robot-assisted radical cystectomy (RARC). We aimed to summarize evidence in this setting with a systematic review and meta-analysis.All published randomized prospective trials that compared ORC with RARC were retrieved through a systematic search according to PRISMA guidelines. Outcomes investigated were the risks of overall complications, high grade (Clavien-Dindo ≥3) complications, positive surgical margins, the number of lymph nodes removed, estimated blood loss, operative time, length of hospital stay, quality of life, overall survival (OS) and progression-free survival. A random effect model was applied. Subgroup analysis on the basis of the urinary diversion was also performed.Seven trials enrolling 974 patients were included. No differences in terms of major oncological and perioperative outcomes between RARC and ORC were observed. However, length of hospital stay was significantly shorter (MD -0.95; 95%CI -1.32, -0.58) and estimated blood loss lower (MD -296.66; 95%CI -462.59, -130.73) for RARC. Operative time was overall shorter for ORC (MD 89.52; 95%CI 55.88, 123.16), however no difference emerged between ORC and RARC with intracorporeal urinary diversion.Despite several limitations due to heterogeneity and possible unaddressed confounding in included trials, we concluded that ORC and RARC represent equally valid options for the surgical treatment of patients with advanced bladder cancer.