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Analysis of Intracorporeal Compared with Extracorporeal Urinary Diversion After Robot-assisted Radical Cystectomy: Results from the International Robotic Cystectomy Consortium

 Kamran Ahmed  ;  Shahid A. Khan  ;  Matthew H. Hayn  ;  Piyush K. Agarwal  ;  Ketan K. Badani  ;  M. Derya Balbay  ;  Erik P. Castle  ;  Prokar Dasgupta  ;  Reza Ghavamian  ;  Khurshid A. Guru  ;  Ashok K. Hemal  ;  Brent K. Hollenbeck  ;  Adam S. Kibel  ;  Mani Menon  ;  Alex Mottrie  ;  Kenneth Nepple  ;  John G. Pattaras  ;  James O. Peabody  ;  Vassilis Poulakis  ;  Raj S. Pruthi  ;  Joan Palou Redorta  ;  Koon-Ho Rha  ;  Lee Richstone  ;  Matthias Saar  ;  Douglas S. Scherr  ;  Stefan Siemer  ;  Michael Stoeckle  ;  Eric M. Wallen  ;  Alon Z. Weizer  ;  Peter Wiklund  ;  Timothy Wilson  ;  Michael Woods 
 EUROPEAN UROLOGY, Vol.65(2) : 340-347, 2014 
Journal Title
Issue Date
Adult ; Aged ; Aged, 80 and over ; Cystectomy/adverse effects ; Cystectomy/methods* ; Europe ; Female ; Humans ; Lymph Node Excision ; Male ; Middle Aged ; Postoperative Complications/etiology ; Republic of Korea ; Retrospective Studies ; Risk Factors ; Robotics* ; Time Factors ; Treatment Outcome ; United States ; Urinary Bladder Neoplasms/pathology ; Urinary Bladder Neoplasms/surgery* ; Urinary Diversion/adverse effects ; Urinary Diversion/methods*
Complications ; Extracorporeal urinary diversion ; Intracorporeal urinary diversion ; Outcomes ; Robot-assisted ; Robotic radical cystectomy ; Urinary diversion
BACKGROUND: Intracorporeal urinary diversion (ICUD) has the potential benefits of a smaller incision, reduced pain, decreased bowel exposure, and reduced risk of fluid imbalance. OBJECTIVE: To compare the perioperative outcomes of patients undergoing extracorporeal urinary diversion (ECUD) and ICUD following robot-assisted radical cystectomy (RARC). DESIGN, SETTING, AND PARTICIPANTS: We reviewed the database of the International Robotic Cystectomy Consortium (IRCC) (18 international centers), with 935 patients who had undergone RARC and pelvic lymph node dissection (PLND) between 2003 and 2011. INTERVENTION: All patients within the IRCC underwent RARC and PLND as indicated. The urinary diversion was performed either intracorporeally or extracorporeally. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Demographic data, perioperative outcomes, and complications in patients undergoing ICUD or ECUD were compared. All patients had at least a 90-d follow-up. The Fisher exact test was used to summarize categorical variables and the Wilcoxon rank sum test or Kruskal-Wallis test for continuous variables. RESULTS AND LIMITATIONS: Of 935 patients who had RARC and PLND, 167 patients underwent ICUD (ileal conduit: 106; neobladder: 61), and 768 patients had an ECUD (ileal conduit: 570; neobladder: 198). Postoperative complications data were available for 817 patients, with a minimum follow-up of 90 d. There was no difference in age, gender, body mass index, American Society of Anesthesiologists grade, or rate of prior abdominal surgery between the groups. The operative time was equivalent (414 min), with the median hospital stay being marginally longer for the ICUD group (9 d vs 8 d, p=0.086). No difference in the reoperation rates at 30 d was noted between the groups. The 90-d complication rate was not significant between the two groups, but a trend favoring ICUD over ECUD was noted (41% vs 49%, p=0.05). Gastrointestinal complications were significantly lower in the ICUD group (p ≤ 0.001). Patients with ICUD were at a lower risk of experiencing a postoperative complication at 90 d (32%) (odds ratio: 0.68; 95% confidence interval, 0.50-0.94; p=0.02). Being a retrospective study was the main limitation. CONCLUSIONS: Robot-assisted ICUD can be accomplished safely, with comparable outcomes to open urinary diversion. In this cohort, patients undergoing ICUD had a relatively lower risk of complications.
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1. College of Medicine (의과대학) > Dept. of Urology (비뇨의학교실) > 1. Journal Papers
Yonsei Authors
Rha, Koon Ho(나군호) ORCID logo https://orcid.org/0000-0001-8588-7584
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