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Oncologic Outcomes of Intracorporeal vs Extracorporeal Urinary Diversion After Robot-Assisted Radical Cystectomy: A Multi-Institutional Korean Study

 Won Sik Ham  ;  Koon Ho Rha  ;  Woong Kyu Han  ;  Tae Gyun Kwon  ;  Tae Hwan Kim  ;  Seung Hyun Jeon  ;  Sang Hyup Lee  ;  Seok Ho Kang  ;  Sung Gu Kang  ;  Jong Kil Nam  ;  Wansuk Kim  ;  Byung Chang Jeong  ;  Ja Hyun Ku  ;  Jong Jin Oh  ;  Sang Chul Lee  ;  Ji Yeol Lee  ;  Sung Hoo Hong  ;  Young Goo Lee  ;  Yong Seong Lee  ;  Sung Yul Park  ;  Young Eun Yoon  ;  Jongchan Kim 
 JOURNAL OF ENDOUROLOGY, Vol.35(10) : 1490-1497, 2021-10 
Journal Title
Issue Date
Cystectomy ; Humans ; Neoplasm Recurrence, Local ; Postoperative Complications ; Prospective Studies ; Republic of Korea ; Retrospective Studies ; Robotic Surgical Procedures* ; Robotics* ; Treatment Outcome ; Urinary Bladder Neoplasms* / surgery ; Urinary Diversion*
cystectomy ; robotic surgical procedure ; urinary bladder neoplasm ; urinary diversion
Background: We aimed to compare the oncologic outcomes of intracorporeal urinary diversion (ICUD) and extracorporeal urinary diversion (ECUD) following robot-assisted radical cystectomy (RARC) in patients diagnosed with bladder cancer. Materials and Methods: Medical records of 730 patients who underwent RARC between April 2007 and May 2019 in 11 tertiary referral centers were retrospectively reviewed. We assessed recurrence-free survival (RFS), cancer-specific survival (CSS), and overall survival (OS) in the two groups using the Kaplan-Meier method. Cox regression models were used to identify factors associated with RFS, CSS, and OS. Results: Among 591 patients, neobladder diversion was performed more frequently in the ICUD group (70.8% vs 52.5%, p = 0.001). The median follow-up duration was shorter in the ICUD group than in the ECUD group (16 vs 26 months, p < 0.001). The rates of overall recurrence (36.5% vs 25.5%, p = 0.013) and pelvic recurrence (12.1% vs 5.9%, p = 0.031) were higher in the ECUD group. However, no differences in 5-year RFS (43.2% vs 58.4%, p = 0.516), CSS (79.3% vs 89.7%, p = 0.392), and OS (74.3% vs 81.4%, p = 0.411) were noted between the two groups. Multivariable analysis revealed that when compared to ICUD, ECUD was not associated with RFS (hazard ratio [HR], 0.982; p = 0.920), CSS (HR, 0.568; p = 0.126), and OS (HR, 0.642; p = 0.124). Conclusion: Although there was a difference in recurrence rate between the two groups, multivariable analysis indicated that the diversion technique after RARC did not affect the oncologic outcomes. Large prospective studies with long-term follow-up are warranted to verify the oncologic outcomes of ICUD and ECUD following RARC.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jong Chan(김종찬) ORCID logo https://orcid.org/0000-0002-0022-6689
Rha, Koon Ho(나군호) ORCID logo https://orcid.org/0000-0001-8588-7584
Han, Woong Kyu(한웅규) ORCID logo https://orcid.org/0000-0002-2527-4046
Ham, Won Sik(함원식) ORCID logo https://orcid.org/0000-0003-2246-8838
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