PURPOSE: To perform an updated systematic review and meta-analysis evaluating patient important outcomes for patients undergoing robot-assisted radical cystectomy (RARC) and open radical cystectomy (ORC). MATERIALS AND METHODS: Multiple scientific databases were searched up to July 2018 for randomized controlled trials that compared RARC and ORC. The primary outcomes of interest were: disease progression, major (Clavien III-V) complications and 90-day quality of life. The quality of evidence was evaluated according to the framework in the Cochrane Handbook for Systematic Reviews of Interventions. RESULTS: Five studies with a total of 540 participants were included in this review. There was no difference between RARC and ORC for disease progression [RR 0.94, 95%CI 0.69-1.29], major complications [RR 1.06, 95%CI 0.75-1.49] or quality-of-life [SMD -0.03, 95%CI -0.27-0.21]. However, RARC demonstrated a reduced risk of requiring a perioperative blood transfusion [RR 0.58, 95%CI 0.43-0.80] and had a marginally lower duration of hospital stay [RR -0.63 days, 95%CI -1.21- -0.05]. Operative time was longer in the RARC group [MD 68.51 minutes, 95%CI 30.55-105.48]. There was no statistically significant difference in local recurrence rates between the procedures [RR 2.08, 95%CI 0.96-4.50], but this difference may be clinically significant and favors ORC. The overall quality of evidence was judged to be moderate. CONCLUSION: Surgical approach does not have a considerable impact on oncological, safety and quality-of-life outcomes for patients undergoing radical cystectomy. The benefits conferred by RARC are the decreased need for blood transfusion and an earlier discharge from hospital.